Abstract
IntroductionThe effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education.ObjectiveTo determine whether ED crowding, as measured by the National ED Overcrowding Scale (NEDOCS) score, has a quantifiable effect on medical student objective and subjective experiences during emergency medicine (EM) clerkship rotations.MethodsWe collected end-of-rotation examinations and medical student evaluations for 21 EM rotation blocks between July 2010 and May 2012, with a total of 211 students. NEDOCS scores were calculated for each corresponding period. Weighted regression analyses examined the correlation between components of the medical student evaluation, student test scores, and the NEDOCS score for each period.ResultsWhen all 21 rotations are included in the analysis, NEDOCS scores showed a negative correlation with medical student tests scores (regression coefficient= −0.16, p=0.04) and three elements of the rotation evaluation (attending teaching, communication, and systems-based practice; p<0.05). We excluded an outlying NEDOCS score from the analysis and obtained similar results. When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011). No part of the medical student rotation evaluation attained significant correlation with the NEDOCS score (p≥0.34 in all cases).ConclusionED overcrowding does demonstrate a small but negative association with medical student performance on end-of-rotation examinations. Additional studies are recommended to further evaluate this effect.
Highlights
The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively
When all 21 rotations are included in the analysis, National ED Overcrowding Scale (NEDOCS) scores showed a negative correlation with medical student tests scores and three elements of the rotation evaluation
When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011)
Summary
The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Emergency Department Crowding length of stay for all patients.[2,3,4,5,6] Solutions have been proposed with the implementation of surge protocols and improvement of both ED workflow and downstream factors.[7,8] In the academic medical setting, an additional concern is the impact of ED crowding on resident and medical student education. Few studies exist in the medical literature assessing the effect of ED crowding on the educational outcomes of residents and medical students. Perceptions of crowding did not correlate with the perception of educational quality in another study.[11]
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