Abstract
Introduction: Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times.Methods: The setting is an urban, academic emergency department with an annual census of 65,000patient visits. Previous analysis of an 18-question emergency medicine faculty survey at this institution identified 5 prevailing domains of faculty instructional performance. The 5 statistically significant domains identified were: Competency and Professionalism, Commitment to Knowledge and Instruction, Inclusion and Interaction, Patient Focus, and Openness and Enthusiasm. We fit a multivariate, random effects model using each of the 5 instructional domains for emergency medicine faculty as independent predictors and throughput time (in minutes) as the continuous outcome. Faculty that were absent for any portion of the research period were excluded as were patient encounters without direct resident involvement.Results: Two of the 5 instructional domains were found to significantly correlate with a change inpatient treatment times within both datasets. The greater a physician’s Commitment to Knowledge and Instruction, the longer their throughput time, with each interval increase on the domain scale associated with a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes). Conversely, increased Openness and Enthusiasm was associated with a 4.45-minute decrease in throughput (90% CI: 8.83 to 0.07 minutes).Conclusion: Some aspects of teaching aptitude are associated with increased throughput times (Openness and Enthusiasm), while others are associated with decreased throughput times (Commitment to Knowledge and Instruction). Our findings suggest that a tradeoff may exist between operational and instructional performance. [West J Emerg Med. 2012;13(2):186–193.]
Highlights
Teaching ability and efficiency of clinical operations are important aspects of physician performance
The greater a physician’s Commitment to Knowledge and Instruction, the longer their throughput time, with each interval increase on the domain scale associated with a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes)
Some aspects of teaching aptitude are associated with increased throughput times (Openness and Enthusiasm), while others are associated with decreased throughput times (Commitment to Knowledge and Instruction)
Summary
Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times. Attending physicians are presented with the critical task of teaching future emergency physicians the medical knowledge and skills needed to successfully care for patients of varying ages, medical conditions, and socioeconomic backgrounds. Unlike a traditional classroom, attending physicians must master the skill of teaching while simultaneously moving patients safely through the ED. There have been few investigations evaluating the association between the quality of EM physician teaching and clinical efficiency. A crucial first step in the promotion of excellence in education and clinical efficiency is discovering
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