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

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 ² = 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.