The effects of overcrowding, boarding, and physician-in-triage on resident education: A scoping review

Emergency department (ED) overcrowding and boarding has been shown to have negative effects on patient care. However, there has been less focus on the effects of overcrowding and boarding on resident education.

We conducted a scoping review to map the current literature on the educational effects of ED overcrowding, summarizing the current research findings and identifying gaps for future research. We sought to answer (1) How is overcrowding defined by individual studies? (2) What educational outcomes have been studied in overcrowding and how have they been measured? (3) What are the educational effects of physician-in-triage (PIT) care models? (4) What educational responses have been initiated in response to ED overcrowding? and (5) What are the effects of those educational responses? We searched Medline, Embase, ERIC, MedEdPortal, Web of Science, and Google Scholar. Two authors independently extracted data. All authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews.

The initial search strategy identified 2570 articles, with 14 articles meeting inclusion criteria. The literature found perceptions of a negative impact of overcrowding and boarding on resident education. However, these negative perceptions have not consistently translated to demonstrably negative educational outcomes. Educational outcomes assessed include measures of resident productivity, procedural experience, in-training examination scores, and perceived measures of teaching quality and educational value. Several studies assessed the impact of PIT models finding changes in the type and volume of patients seen by residents as a result.

This scoping review summarizes the existing literature assessing the educational impact of ED overcrowding and boarding as well as PIT models. The review provides context and insights for future research into these effects.