Written by Shannon Markus
Spoon Feed
When compared to working solo as an emergency physician (EP), productivity is positively influenced by the presence of senior residents, minimally affected by junior residents, and negatively impacted or neutral with medical students.
Speed me up or slow me down?
In teaching hospitals, balancing learner education with efficient, high-quality patient care is a constant challenge. As patients grow more medically complex and issues like ED boarding persist, optimizing throughput — including through resident and student staffing — is essential. Much of the existing data on learner impact in the ED is outdated and may not reflect current and evolving conditions. This retrospective cohort study (4/2022–3/2023) examined how learner arrangements affect ED productivity (measured in patients per hour) in ambulatory and non-ambulatory care areas at two tertiary teaching hospitals in Ottawa. Analyzing 8,161 shifts, the study found that senior residents increased productivity to 2.6 patients/hour in ambulatory care (vs 2.1 for solo EP). In contrast, medical students generally decreased productivity or had a neutral effect. Working with junior residents resulted in a small increase in EP productivity. The authors only looked at 2 Canadian tertiary teaching hospitals, so it may lack generalizability, and it did not account for factors like patient complexity, physician experience, or learner skill variability.
How will this change my practice?
The study suggests that scheduling strategies that optimize resident involvement could enhance ED efficiency. While I don’t manage resident scheduling at my shop, being aware of my learners’ training levels can help inform my game plan for the shift. The productivity trends in this study align with my sense of whether my assigned trainees will speed me up or slow me down. Perhaps next time I’m assigned a medical student (or two), I’ll make a more of a conscious effort to pick up patients on my own.
Source
The impact of various learner arrangements on emergency department staff productivity. CJEM. 2024 Dec;26(12):883-889. doi: 10.1007/s43678-024-00775-4. Epub 2024 Sep 25. PMID: 39317878
