Beyond the Numbers: How Clinical Performance Metrics Impact Emergency Medicine Residents

Emergency physicians commonly receive feedback in the form of performance metrics such as patients seen per hour. Reviewing metrics has been associated with increased stress and burnout. Although effects on efficiency have been examined, studies have not yet investigated the potential psychological and motivational impacts of providing performance metrics to residents during training. In this study we explore residents' interest in receiving performance metrics during training and how receiving performance metrics might affect their 1) perceived pressure and motivation to change performance, 2) perspectives on the importance and actionability of metrics, 3) perceived readiness to receive metrics after graduation, and 4) possible effects on their postgraduate career plans.

Senior emergency medicine residents at a single, quaternary-care training center completed an anonymous pre-metric survey using a 5-point Likert scale of agreement (1 = strongly agree, 5 = strongly disagree) on the psychological and motivational impacts of receiving performance metrics. All senior residents, regardless of survey completions, were then given the option to view their personal performance metrics in comparison to deidentified metrics for the senior classes. Residents who viewed their metrics were offered the opportunity to complete the post-metric survey, which was identical to the pre-metric survey. Resident interest in viewing their metrics was recorded, and we compared survey responses using unpaired t-tests.

All 26 residents (100%) chose to view their metrics, 25 (96%) completed the pre-metrics survey and 17 (73%) completed the post-metrics survey. After receiving performance metrics, residents reported feeling less pressure to change their performance (pre-metrics mean 2.32 [standard deviation 0.80]), post-metrics mean 3.05 [0.71], P < .01), and they reported feeling more prepared to receive metrics after graduation (pre-metrics mean 2.32 [0.95], post-metrics mean 1.68 [0.58], P = .01]. There was no significant change in residents' responses to questions about metrics perceptions, motivation, or interest in administrative leadership after graduation.

This single-site, academic study indicated that senior residents are interested in seeing their personalized and deidentified group performance metrics and that viewing these metrics increases their sense of preparedness for graduation without necessarily affecting the pressure or motivation they felt during training.