Experience and training as factors in physician performance in a pediatric emergency room

The medical records of 463 children seen in a hospital emergency room were studied prospectively to examine the influence of physicians' experience on their performance in the emergency room. The diagnostic and therapeutic approach of three groups of physicians to the following problems were studied: fever lasting less than 24 h or 2-7 days, diarrhea and dyspnea. The results show that less experienced physicians (residents in their first week of practice in the emergency room) tended to request a significantly greater number of laboratory tests than the senior physicians, but tended to prescribe less medications, particularly those used for symptomatic treatment. Following 3 months' training in the emergency room, these residents generally exhibited a pattern of laboratory utilization similar to that of their respective seniors; however, the residents demonstrated a significantly increased propensity to diagnose more patients as having bacterial infections and to prescribe more antibiotics. In addition to the attention paid to young physicians' diagnostic utilization performance, their therapeutic pattern of practice should also be assessed.