Written by Chris Thom
Spoon Feed
This was a systematic review of the impact of medical trainees on efficiency and productivity in emergency medicine (EM). The authors found a slight increase in length of stay with medical trainees overall and an increased RVU productivity with EM residents.
RVU – residents valuable to U
This was a systematic review of 13 studies that assessed the impact of medical trainees on efficiency and productivity in EM. Study designs were varied and included assessment of before and after periods when EM residencies started, as well as evaluating patient encounters that were seen by only an EM attending versus both an EM attending and resident. There was a moderate to high risk of bias and confounding variables, which resulted in a low-grade evidence recommendation for the primary outcomes of this review. The efficiency impact of medical trainees was variable in the included studies, but with a median increase in length of stay (LOS) of 26 minutes for residents and 14 minutes for student trainees. Productivity was assessed in terms of RVU production and patients per hour. Students had no impact on productivity, while EM residents were associated with increased patients per hour (+0.26) and increased RVU production (+ 0.76 RVU/hour).
How will this change my practice?
Do medical trainees slow down EM physicians due to teaching time and associated inefficiency? Or do they handle tasks such as discharge conversations, prescription writing, and consultant phone calls that then free up EM attendings to continue seeing patients and thus increase productivity? The truth is that it likely depends on the trainee type and the practice setting. However, EM residents are associated with increased productivity both in terms of RVUs and patients per hour, offset by a small increase in length of stay. This has important implications for several stakeholders, including community sites that may want to understand the impact of hosting EM residents at their respective sites.
Source
Impact of Medical Trainees on Efficiency and Productivity in the Emergency Department: Systematic Review and Narrative Synthesis. West J Emerg Med. 2024 Sep;25(5):767-776. doi: 10.5811/westjem.18574. PMID: 39319808; PMCID: PMC11418871.
