Productivity and Efficiency Growth During Emergency Medicine Residency Training

Area of Science:

• Medical Education
• Emergency Medicine
• Healthcare Analytics

Background:

• Emergency medicine (EM) resident training emphasizes efficiency and productivity for safe post-graduation practice.
• Multitasking is a key Accreditation Council for Graduate Medical Education (ACGME) milestone, often assessed via observation.
• Quantitative metrics like patients seen per hour (PPH) can enhance resident training and experience.

Purpose of the Study:

• Analyze resident productivity and efficiency trends using quantitative data.
• Define the learning curve for resident PPH over time.
• Investigate additional throughput metrics, such as door-to-decision time (DTDT), and their relationship to training progression.

Main Methods:

• Retrospective, observational study in a high-volume tertiary care emergency department (ED).
• Analysis included 42 residents and 79,232 adult patients over 30 months (July 2019-December 2021).
• An exponential regression model was used to assess PPH, with adjustments for patient covariates and postgraduate year (PGY).

Main Results:

• Median PPH increased from 0.898 to 1.425 over the study period.
• Median PPH by PGY was 1.13 (PGY 1), 1.38 (PGY 2), and 1.38 (PGY 3), indicating a plateau in the second year.
• Median DTDT improved progressively: 185 minutes (PGY 1), 171 minutes (PGY 2), and 166 minutes (PGY 3).

Conclusions:

• Resident PPH improves throughout EM training but tends to plateau by the second postgraduate year.
• Door-to-decision time (DTDT) demonstrates continuous improvement across all three years of residency.
• These quantitative metrics are vital for assessing and enhancing resident performance and ED operational efficiency.