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ObjectivesEmergency physician productivity, often defined as new patients evaluated per hour, is essential to planning clinical operations. Prior research in this area considered this a static quantity; however, our group’s study of resident physicians demonstrated significant decreases in hourly productivity throughout shifts. We now examine attending physicians’ productivity to determine if it is also dynamic.MethodsThis is a retrospective cohort study, conducted from 2014 to 2016 across three community hospitals in the north-eastern USA, with different schedules and coverage. Timestamps of all patient encounters were automatically logged by the sites’ electronic health record. Generalised estimating equations were constructed to predict productivity in terms of new patients per shift hour.Results207 169 patients were seen by 64 physicians over 2 years, comprising 9822 physician shifts. Physicians saw an average of 15.0 (SD 4.7), 20.9 (SD 6.4) and 13.2 (SD 3.8) patients per shift at the three sites, with 2.97 (SD 0.22), 2.95 (SD 0.24) and 2.17 (SD 0.09) in the first hour. Across all sites, physicians saw significantly fewer new patients after the first hour, with more gradual decreases subsequently. Additional patient arrivals were associated with greater productivity; however, this attenuates substantially late in the shift. The presence of other physicians was also associated with slightly decreased productivity.ConclusionsPhysician productivity over a single shift follows a predictable pattern that decreases significantly on an hourly basis, even if there are new patients to be seen. Estimating productivity as a simple average substantially underestimates physicians’ capacity early in a shift and overestimates it later. This pattern of productivity should be factored into hospitals’ staffing plans, with shifts aligned to start with the greatest volumes of patient arrivals.

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Research exploring American Indian (AI) youth drinking motives and their relation to negative outcomes is critical due to higher rates of alcohol use and early exposure to intoxication in the population. The purpose of this study is to explore classes of drinking motives as they relate to heavy episodic drinking, perceived discrimination, religious importance, ethnic identity, and ethnic pride. This study is part of an ongoing epidemiologic and etiologic investigation of substance use among AI youth drinkers living on or near reservations (n ϭ 1,934, M age ϭ 15.31). A latent class analysis (LCA) was conducted to discern latent classes of drinking motives. Once latent classes were identified, differences in perceived discrimination, ethnic pride, ethnic identity, religious importance, and heavy episodic drinking were tested. A 2-class solution provided the best overall model fit to the data. The higher coping and enhancement motive class was associated with significantly greater heavy episodic drinking, perceived discrimination, and ethnic identity compared with the low motive class. Further, the class structure did not differ between 7th and 8th graders and 9th-12th graders. Results indicate that among AI youth, the class with strong motives to drink for coping or enhancement had higher ethnic identity, greater risk of heavy episodic drinking, and greater perceived discrimination compared with the class with low motives. Future research should examine additional factors and stressors that may be associated with these classes of drinking motives and are unique to the AI population.

Background: Undergraduates may not use the most effective learning strategies, particularly those considered “desirable difficulties” such as spacing, elaboration, and testing (“SET”). Objective: This study examined knowledge-based, metacognitive, and behavioral outcomes from interventions designed to teach undergraduates about the “SET” strategies and about behavior change techniques to support adoption of these study behaviors. Method: Introductory psychology students ( n = 244) received a learning-strategies-only intervention (LS), a learning-strategies-plus-behavior-change (LS+BC) intervention, or no intervention. They completed three assessment surveys to measure outcomes across the semester. Results: Intervention participants showed enhanced knowledge of the “SET” strategies. LS participants rated testing as more helpful, reported higher use of elaboration and testing, and had marginally higher final course grades than the control group. Adding behavior-change training did not enhance the outcomes. Growth mindset was associated with greater intervention-related gains on several measures. Conclusion: Curriculum-embedded LS training was associated with positive shifts in “SET” strategy knowledge and with behavioral changes for two strategies. Teaching Implication: This study provides evidence of the benefits of LS training as integrated into the introductory psychology curriculum, and can help guide educators to support students in acquiring more effective study strategies.