Toward a new paradigm: goal-based residency training

Area of Science:

• Medical Education
• Emergency Medicine Training
• Clinical Experience Quantification

Background:

• Length of training is an insufficient proxy for emergency medicine (EM) resident clinical experience.
• Quantitative data on resident clinical encounters are scarce.
• Understanding clinical exposure variation is crucial for effective EM residency programs.

Purpose of the Study:

• Quantify clinical encounters for EM residents during a 3-year program.
• Characterize encounters by patient acuity, age, and specific diagnoses.
• Assess inter-resident variability in clinical experience.

Main Methods:

• Retrospective analysis of emergency department (ED) databases from two training hospitals.
• Inclusion of three resident cohorts (2003-2008 entry years).
• Data collected on resident postgraduate year (PGY), patient acuity (ESI), diagnosis (ICD-9-CM), and age.

Main Results:

• Median 4,836 ED clinical encounters per resident (range: 3,831-5,780).
• Clinical encounters increased from PGY1 to PGY3 (30% and 14% respectively).
• Significant inter-resident variability (30-60%), particularly in pediatric and critical care cases; underrepresentation of low-acuity and rare high-risk conditions.

Conclusions:

• Develop methods to reduce variability in resident clinical encounter numbers and types.
• Supplement residency curriculum to address rare conditions and ensure comprehensive exposure.
• Align clinical training with the anticipated demands of EM practice.