Narrative Review of Clinical Productivity and Teaching in Emergency Medicine.

Matthew D Zuckerman,Sophia Lin,Fawziah Alsalmi,Simiao Li-Sauerwine

doi:10.7759/cureus.14309

Abstract

Emergency medicine educators are subject to external pressures to increase clinical productivity while maintaining quality teaching. Strategies to mitigate this perceived conflict include alterations in staffing and incentive compensation with educational value units. There is a paucity of information describing the effect of clinical demands on teaching metrics in emergency medicine. We performed a narrative review of the literature describing the relationship between clinical productivity and teaching evaluations of emergency medicine faculty and residents. We searched PubMed and Google Scholar for peer-reviewed articles describing emergency medicine clinical productivity metrics, teaching metrics, and the relationship between them. Seven articles met inclusion criteria. While most articles utilized relative value units (RVUs) per hour, other outcomes metrics were heterogeneous. Almost all studies utilized retrospective data and took place at academic teaching hospitals. Despite variability in statistical analysis, no studies found a relationship between clinical productivity and teaching metrics. Multiple articles identified characteristics of faculty that were associated with improved teaching metrics independent of clinical demands. The available literature does not support the concept that increased clinical productivity conflicts with quality teaching. A subset of faculty was identified who excelled at both. Next research steps should include developing shared standards for assessment of clinical productivity and educational quality that can be used to collect data at multiple sites at academic and community clinical settings; a secondary outcome includes measuring the effects of additional teaching attendings and educational value units.

Highlights

BackgroundEmergency medicine providers face ever-growing pressure to increasing clinical productivity, leading to a pressing concern that they will have less time to teach and supervise residents and students [1,2]
In an effort to protect time dedicated to teaching from the encroaching demands of clinical productivity, some academic emergency departments have instituted initiatives to incentivize time spent teaching
These include dedicated teaching shifts and the introduction of educational value units, a metric modeled after the relative value unit (RVU) aimed at quantifying faculty teaching efforts [6,7,8,9]

Summary

Introduction

BackgroundEmergency medicine providers face ever-growing pressure to increasing clinical productivity, leading to a pressing concern that they will have less time to teach and supervise residents and students [1,2]. In an effort to protect time dedicated to teaching from the encroaching demands of clinical productivity, some academic emergency departments have instituted initiatives to incentivize time spent teaching These include dedicated teaching shifts and the introduction of educational value units, a metric modeled after the relative value unit (RVU) aimed at quantifying faculty teaching efforts [6,7,8,9]. Several studies have examined whether an increased focus on billing, documentation, and patient satisfaction adversely affects the quality of education in the emergency department These studies are fairly heterogeneous and do not directly address whether the quality of resident education impacts clinical productivity [1,13,14,15,16]. We sought to collate the outcomes used by researchers to measure teaching efficacy

Methods

Results

Discussion

Conclusion