The educational value of emergency department teaching: it is about time

Abstract

There is a paucity of research on the quality and quantity of clinical teaching in the emergency department (ED) setting. While many factors impact residents' perceptions of attending physicians' educational skill, the authors hypothesized that the amount of time residents spend with attending in direct teaching is a determinant of residents' perception of their shift's educational value. Researchers shadowed emergency medicine (EM) attendings during ED shifts, and recorded teaching time with each resident. Residents were surveyed on their assessment of the educational value (EV) of the shift and potential confounders, as well as the attending physician's teaching quality using the ER Scale. The study was performed in the EDs of two urban teaching hospitals affiliated with an EM residency program. Subjects were EM residents and rotators from other specialties. The main outcome measure was the regression of impact of teaching time on EV. Researchers observed 20 attendings supervising 47 residents (mean 2.35 residents per attending, range 2-3). The correlation between teaching time in minutes (mean 60.8, st.dev 25.6, range 7.6-128.1) and EV (mean 3.45 out of 5, st. dev 0.75, range 2-5) was significant (r = 0.302, r = 0.091, p< 0.05). No confounders had a significant effect. The study shows a moderate correlation between the total time attendings spend directly teaching residents and the residents' perception of educational value over a single ED shift. The authors suggest that mechanisms to increase the time attending physicians spend teaching during clinical shifts may result in improved resident education.

Resident Supervision and Patient Care: A Comparative Time Study in a Community‐Academic Versus a Community Emergency Department

“…This translates to 68 minutes over an 8‐hour shift, consistent with the supervision time found by Hexom et al . Time spent interacting with EPs may determine perceived education quality by the residents . This also echoes the positive responses from the residents to our survey.…”

“…Second, we confirmed that our EPs spent the majority of their time performing direct patient care . More importantly, even though the EPs devoted a substantial amount of their time to resident supervision at the CAED, direct patient care time did not change significantly.…”

“…Hypothesis 1. A recent study by Hexom et al . reported a mean resident supervision time by EM faculty of 60.8 minutes over 8‐hour observation periods.…”

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016

“…Three of these studies with an experimental design were highlighted . There was a decline in the number of observational studies (35/75; 47%), compared to 2015 (36/61; 59%), but an increase in the number of studies using survey methodology (19/75; 25%) in 2016 compared to 10 of 61, 16% in 2015, and 0% in 2014. It should be noted that all survey studies in this review drew data from participants from multiple institutions per the predetermined selection criteria.…”

“…Excluding surveys, 10 studies (13%) were conducted at two or more institutions. This is similar to 2015 where 10 of 61 (16%) were multi‐institutional.…”