Impact of medical students and residents on emergency department productivity

Evidence on the impact of learners on emergency department (ED) productivity remains inconclusive. This study aimed to evaluate the association between the presence, number, and experience level of learners and the total number of patients treated per attending physician per shift (patients per shift) and per hour (patients per hour).

This observational, cohort study was conducted at the Hôpital du Sacré-Coeur de Montréal. All attending physicians shifts from January 1, 2017, to December 31, 2019, were considered for inclusion. Shifts involving specific non-clinical objectives (i.e., ED coordination or trauma team leader), those ≤ 5 h long, or those with missing critical data were excluded. Linear mixed models were used to assess the independent associations between the number of learners, their experience level, and productivity outcomes.

Of 11,851 shifts, 10,727 were included (no learner: n = 2,713; one learner: n = 7,001; two learners: n = 1,013). Patients per shift and per hour were independently associated with the number of learners (reference category: no learner; patients per shift: one learner = + 1.60 [95% CI 1.45-1.74]; two learners = + 3.03 [95% CI 2.79-3.26]; patients per hour: one learner = + 0.14 [95% CI 0.13-0.16]; two learners = + 0.26 [95% CI 0.24-0.29]). Significant differences were also observed across learner experience levels (reference category: no learner; patients per shift: medical students = + 0.63 [95% CI 0.44-0.81] to PGY5 residents = + 4.42 [95% CI 4.05-4.78]; patients per hour: medical students = + 0.04 [95% CI 0.02-0.06] to PGY5 residents = + 0.46 [95% CI 0.42-0.50]).

The presence of learners during ED shifts was associated with greater attending-physician productivity, including junior learners, with incremental gains as the number and level of learners increased. Aligning learner schedules with periods of high ED volume could maximize operational benefits.