AEM Education and Training最新文献_第10页

The 2023 emergency medicine match: Alarming symptom of a health care system in crisis 2023 年急诊医学竞赛：医疗系统危机的警示症状

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10947

Alexander Y. Sheng MD, MHPE, Philip A. Gruppuso MD, Selim Suner MD, MS, Eli Y. Adashi MD, MS

引用次数: 0

Second- and third-year medical students’ clinical encounters in the emergency department 二年级和三年级医科学生在急诊科的临床表现

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10937

Ines Hoxha MD, Daniel J. Hekman MS, Benjamin Schnapp MD, Med

Background

Experiential learning theory suggests that direct clinical experiences facilitate learning. Previous literature has focused primarily on the experiences of fourth-year medical students. As more students gain early clinical exposure, it is important to understand the types of patients seen by junior students.

Objectives

This study aims to categorize the clinical experiences of early (M2 and M3) students in the emergency department (ED).

Methods

A retrospective review of the electronic health record of patients seen by M2s and M3s on a 2-week emergency medicine rotation at a single urban academic ED in the Midwest was performed. Data elements extracted included total number of patients seen, Emergency Severity Index (ESI), disposition, and chief complaint. Students were not mandated to see any particular patients.

Results

Medical students (248) saw 2994 total patients from 2018 to 2022. The median number of patients seen by each student was 12.0 (range 1–32). Pediatric patients made up 6.5% (n = 194) of total patients. Encounters were primarily ESI 2 or 3, which accounted for 89.4% of all patients (n = 2676). The most encountered complaints were abdominal pain, chest pain, and dyspnea, making up 15.6% (n = 467), 8.7% (n = 260), and 5.5% (n = 165), respectively, of total cases. Obstetrics/gynecology, hematologic, and environmental disorders were the least frequently encountered domains. No students saw all Clerkship Directors in Emergency Medicine (CDEM)–recommended complaints.

Conclusions

There is significant variability in the ED encounters of M2s and M3s, with wide ranges of patient volume and presentations. This study provides some evidence that early students may not be meeting CDEM recommendations.

背景经验学习理论认为，直接的临床经验有助于学习。以往的文献主要关注四年级医学生的经验。随着越来越多的学生开始接触早期临床，了解低年级学生所见患者的类型就显得尤为重要。目的本研究旨在对低年级（M2 和 M3）学生在急诊科（ED）的临床经验进行分类。方法在美国中西部的一个城市学术急诊科，对 M2 和 M3 学生在为期两周的急诊科轮转中就诊病人的电子健康记录进行回顾性审查。提取的数据元素包括就诊患者总数、急诊严重程度指数（ESI）、处置和主诉。学生没有被强制要求看任何特定的病人。结果从 2018 年到 2022 年，医科学生（248 人）共接诊了 2994 名患者。每名学生接诊患者人数的中位数为 12.0（范围为 1-32）。儿科患者占患者总数的 6.5%（n = 194）。就诊患者主要是ESI 2或3级患者，占所有患者的89.4%（n = 2676）。最多的主诉是腹痛、胸痛和呼吸困难，分别占总病例的 15.6%（n = 467）、8.7%（n = 260）和 5.5%（n = 165）。妇产科、血液病和环境紊乱是最不常见的疾病。没有学生看过急诊科实习主任（CDEM）推荐的所有主诉。结论 M2 和 M3 的急诊室就诊情况存在很大差异，病人数量和就诊情况也有很大不同。这项研究提供了一些证据，表明早期学生可能没有达到 CDEM 的建议。

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引用次数: 0

Journey through diagnosis 诊断之旅

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10941

Antonio Yaghy MD

This reflective poem explores the profound human impact of receiving a serious medical diagnosis. The speaker grapples with the emotional upheaval of this sudden severing from one's presumed healthy future. There are attempts to cling to denial or bargain for a different outcome. But the truth of the diagnosis persists, sending ripples of change throughout the patient's life. Dreams slip away and plans evaporate in the crucible of illness. After a struggle, the mind makes peace and courageously leans into the difficulties ahead. The poem celebrates the human capacity to accept vulnerability, find gifts within trials, and walk the remaining road with wisdom. It reflects on how a diagnosis can heighten awareness that life is fleeting and precious. The accompanying digital artwork was generated using OpenAI's DALL·E 3 and modified using Adobe Firefly. It is a stark, black canvas, which can be seen as a metaphor for the profound and contemplative journey described patients go through. It symbolizes the inner darkness and uncertainty faced when confronting life-altering diagnoses, echoing the feelings of isolation, the search for meaning, and the gradual acceptance of a new reality as one navigates through the trials of illness.

这首反思诗探讨了接受严重医疗诊断对人类的深刻影响。诗中的作者努力应对这种突然与自己假定的健康未来断绝关系所带来的情感波动。有人试图坚持否认，或讨价还价以求不同的结果。但诊断的真相依然存在，给病人的生活带来了巨大的变化。在疾病的煎熬下，梦想悄然离去，计划烟消云散。经过一番挣扎，心灵得到平静，勇敢地迎接未来的困难。这首诗颂扬了人类接受脆弱、在磨难中发现天赋、用智慧走完剩余道路的能力。这首诗反映了疾病诊断如何使人们更加意识到生命的短暂和珍贵。附带的数字艺术作品是使用 OpenAI 的 DALL-E 3 生成的，并使用 Adobe Firefly 进行了修改。这是一幅黑色的油画，隐喻了患者所经历的深刻而沉思的旅程。它象征着在面对改变生命的诊断时所面临的内心黑暗和不确定性，呼应了人在经历疾病考验时的孤独感、对意义的追寻以及对新现实的逐渐接受。

引用次数: 0

Development and evaluation of a novel knowledge assessment tool for pediatric emergency medicine clerkships 开发和评估用于儿科急诊医学实习的新型知识评估工具

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10938

Xian Zhao MD, MEd, Aneka Khilnani MS, Debra L. Weiner MD, PhD, Katie A. Donnelly MD, MPH, Christina E. Lindgren MD, Jennifer Chapman MD, Pavan Zaveri MD, MEd, William Benjamin Prince MD, Rosemary Thomas-Mohtat MD

Objectives

This study seeks to determine validity evidence for a newly developed multiple-choice examination (MCE) tool to assess retention and application of medical knowledge of students enrolled in a pediatric emergency medicine (PEM) clerkship.

Methods

A team of PEM physicians created a 110-item MCE covering the range of clinical topics in PEM relevant for medical students. The researchers determined examination content using the report of Clerkship Directors in Emergency Medicine and PEM Interest Group of the Society for Academic Emergency Medicine (SAEM). The authors administered the MCE to fourth-year medical students at the end of their PEM rotation from May 2020 to April 2023 at four institutions and then analyzed the examination using four of Messick's five sources of validity evidence: content, response process, internal structure, and relation to other variables.

Results

A total of 158 students took the test. In academic year (AY)20–21, 47 students took the test and scored, on average, 81%. After revision of poor and indeterminate questions, the 111 medical students who took the revised version of the test in AY21–AY23 scored on average 77.3% with a standard deviation of 5.7% with a normal distribution in scores. The revised questions were rated as excellent (10.0%), good (26.4%), fair (34.5%), poor (24.5%), or indeterminate (4.5%) based on test item discrimination. There was a positive correlation between MCE scores and students' clinical evaluations but no correlation between MCE scores and scores that students received on their clinical notes or patient presentations during case conference.

Conclusions

This novel PEM clerkship examination is a reliable test of medical knowledge. Future directions involve evaluating consequences of the MCE and offering the test to medical students in a dedicated PEM rotation at the national level.

目的本研究旨在确定新开发的多选题考试（MCE）工具的有效性，以评估参加儿科急诊医学（PEM）实习的学生对医学知识的掌握和应用情况。方法由儿科急诊医学医生组成的一个团队开发了一个包含 110 个项目的 MCE，涵盖了与医学生相关的儿科急诊医学临床课题。研究人员根据急诊医学实习主任和急诊医学学术学会（SAEM）儿科急诊医学兴趣小组的报告确定了考试内容。作者于 2020 年 5 月至 2023 年 4 月在四所院校对四年级医学生在 PEM 轮转结束时进行了 MCE 考试，然后使用梅西克五种有效性证据来源中的四种对考试进行了分析：内容、反应过程、内部结构以及与其他变量的关系。结果共有 158 名学生参加了考试。在 20-21 学年，有 47 名学生参加了测试，平均得分率为 81%。在对差题和不确定题进行修订后，111 名医学生在 21-23 学年参加了修订版测试，平均得分率为 77.3%，标准差为 5.7%，得分呈正态分布。根据测试题目的区分度，修订版试题被评为优（10.0%）、良（26.4%）、一般（34.5%）、差（24.5%）或不确定（4.5%）。MCE 分数与学生的临床评价之间呈正相关，但 MCE 分数与学生在临床笔记或病例讨论中的病人陈述所获得的分数之间没有相关性。结论这种新颖的 PEM 实习考试是一种可靠的医学知识测试。未来的发展方向包括对 MCE 的后果进行评估，并在全国范围内向专门参加 PEM 轮转的医学生提供该测试。

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引用次数: 0

Application of motor learning theory to teach the head impulse test to emergency medicine resident physicians 应用运动学习理论教授急诊科住院医生头部冲力测试

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10936

Jacob C. Lenning MD, Anne M. Messman MD, Jeffrey A. Kline MD

Objectives

The objective was to develop an innovative method of training emergency medicine (EM) resident physicians to perform the head impulse test (HIT) component of the HINTS (head impulse test, nystagmus, test of skew) examination using video-oculography (VOG) device feedback.

Methods

Using principles from motor learning theory and Ericsson's framework for expertise, we developed a training innovation utilizing VOG device feedback to teach the degree (10°–20°) and velocity (>100°/s) of head turn required for the HIT. We assessed the technical ability of participants to perform the HIT using the VOG device, without feedback, to count the number of successful HITs out of 20 attempts before, immediately after, and 2 weeks after the training innovation. Participants rated their confidence on a 1 to 5 Likert scale before and 2 weeks after training.

Results

Most participants (11 of 14, 78%) were unable to perform even one successful HIT in 20 attempts before training despite brief verbal and visual instruction regarding the head turn parameters. However, most participants achieved more than one success, in fact, all with at least five successes, immediately after training (13 of 14, 93%) and again 2 weeks after training (nine of 11, 82%). The median (interquartile range) number of successful HITs was 0 (0, mean 0.79) during baseline testing, 7.5 (5.8) immediately after training, and 10 (8.0) 2 weeks after training (p < 0.01, Kruskal–Wallis). The median confidence rating increased from 1.5 (1) before baseline testing to 3 (1.5) after follow-up testing (p = 0.02, Mann–Whitney U).

Conclusions

Prior to motor training, most participants failed to properly perform the HIT. Feedback training with VOG devices may facilitate development of the skills required to properly perform the HIT. Further study is needed to assess the ability to train the interpretive aspect of the HIT and other components of the HINTS examination.

目的开发一种创新方法，培训急诊医学（EM）住院医师使用视频眼动图（VOG）设备反馈执行 HINTS（头部冲动测试、眼球震颤、偏斜测试）检查中的头部冲动测试（HIT）部分。方法我们利用运动学习理论的原理和爱立信的专业知识框架，开发了一种利用 VOG 设备反馈来教授 HIT 所需的转头程度（10°-20°）和速度（>100°/s）的创新训练方法。我们评估了参与者在没有反馈的情况下使用 VOG 设备进行 HIT 的技术能力，以计算在培训创新之前、之后和之后 2 周内 20 次尝试中成功 HIT 的次数。在训练前和训练两周后，参与者用 1 到 5 分的李克特量表对自己的信心进行评分。结果大多数参与者（14 人中有 11 人，占 78%）在训练前的 20 次尝试中，尽管有简短的关于转头参数的口头和视觉指导，但仍无法成功完成一次 HIT。然而，大多数参与者都取得了一次以上的成功，事实上，所有参与者都取得了至少五次成功，这在训练后立即取得（14 人中有 13 人，占 93%），并在训练两周后再次取得（11 人中有 9 人，占 82%）。在基线测试期间，成功 HIT 的中位数（四分位数之间的范围）为 0（0，平均值为 0.79），培训后为 7.5（5.8），培训 2 周后为 10（8.0）（p < 0.01，Kruskal-Wallis）。信心评分的中位数从基线测试前的 1.5 (1) 增加到后续测试后的 3 (1.5)（p = 0.02，Mann-Whitney U）。结论在进行运动训练之前，大多数参与者都无法正确完成 HIT。使用 VOG 设备进行反馈训练可促进正确完成 HIT 所需的技能发展。还需要进一步的研究来评估 HIT 的解释能力和 HINTS 检查的其他组成部分。

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引用次数: 0

Systematic online academic resource (SOAR) review: Pediatric respiratory infectious disease 系统性在线学术资源（SOAR）回顾：小儿呼吸道传染病

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10945

Joshua Belfer MD, Cindy G. Roskind MD, Andrew Grock MD, JooYeon Jung MD, Shirley W. Bae MD, Lisa Zhao MD, Brad Sobolewski MD, MEd

Background

Free open access medical education (FOAM) resources have become increasingly popular in graduate medical education. Despite their accessibility, the assessment of FOAM resources’ quality is challenging due to their decentralized nature and the diverse qualifications of their authors and distribution platforms. In this first pediatric systematic online academic resource (SOAR) review, we utilized a systematic methodology to aggregate and assess the quality of FOAM resources on pediatric respiratory infectious disease topics.

Methods

We searched 177 keywords using FOAMSearch, the top 50 FOAM websites on the Social Media Index, and seven additional pediatric emergency medicine–focused blogs. Following a basic initial screen, resources then underwent full-text quality assessment utilizing the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool.

Results

The search yielded 44,897 resources. After 44,456 were excluded, 441 underwent quality assessment. A total of 36/441 posts (8% of posts) reached the high-quality threshold score (rMETRIQ ≥ 16). The most frequent topics overall were pneumonia and bronchiolitis. A total of 67/441 posts (15% of posts) were found to have a rMETRIQ score of less than or equal to 7, which may indicate poor quality.

Conclusions

We systematically identified, described, and performed quality assessment on FOAM resources pertaining to the topic of pediatric respiratory infectious disease. We found that there is a paucity of high-quality posts on this topic. Despite this, the curated list of high-quality resources can help guide trainees and educators toward relevant educational information and suggest unmet needs for future FOAM resources.

背景免费开放医学教育（FOAM）资源在医学研究生教育中越来越受欢迎。尽管这些资源很容易获取，但由于其分散的性质以及作者和发布平台的资质各不相同，因此对其质量进行评估具有挑战性。在这篇儿科系统性在线学术资源（SOAR）综述中，我们采用了一种系统的方法来汇总和评估有关儿科呼吸道传染病主题的 FOAM 资源的质量。方法我们使用 FOAMSearch 搜索了 177 个关键词、社交媒体索引中排名前 50 的 FOAM 网站以及另外 7 个以儿科急诊医学为重点的博客。在进行了基本的初步筛选后，我们利用修订后的医学教育转化资源进行了全文质量评估：影响和质量 (rMETRIQ) 工具进行全文质量评估。结果搜索到 44,897 条资源。排除 44456 篇后，对 441 篇进行了质量评估。共有 36/441 篇帖子（占帖子总数的 8%）达到了高质量阈值分数（rMETRIQ ≥ 16）。最常见的主题是肺炎和支气管炎。共有 67/441 篇帖子（占帖子总数的 15%）的 rMETRIQ 分数小于或等于 7，这可能表明帖子质量较差。结论我们对有关儿科呼吸道传染病主题的 FOAM 资源进行了系统的识别、描述和质量评估。我们发现，有关这一主题的高质量文章很少。尽管如此，高质量资源的策划列表有助于引导学员和教育工作者了解相关的教育信息，并为未来的 FOAM 资源提出尚未满足的需求。

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引用次数: 0

Teaching residents to teach: A pilot study for an innovative online curriculum 教住院医师教学：创新在线课程试点研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-21 DOI: 10.1002/aet2.10946

Jonathan E. Karademos MD, MEHP, Lalena M. Yarris MD, MCR, Eric Steinberg DO, MEHP

Introduction

Resident-as-teacher (RAT) curricula have improved teaching behavior, ability, and confidence among resident participants. However, there are limited data on the appropriate format, length, and content. With teaching being a core residency competency and residents delivering one-third of student teaching in the clinical setting, properly training residents in clinical teaching is essential. We created a formal, scalable, asynchronous RAT curriculum. We report the pilot implementation of this curriculum along with feasibility, user acceptability, and preliminary knowledge outcomes.

Methods

In this pilot pre–post interventional study, senior emergency medicine residents completed a formalized online education curriculum during their “teach month.” The curriculum consisted of three online modules completed weekly over a 4-week rotation. Topics included adult learning, assessment and feedback, and group teaching. Several surveys were sent to residents before and after curriculum implementation. The surveys rated satisfaction and asked several education-specific knowledge questions to assess learning. Ratings were analyzed using means and confidence intervals (95%). Knowledge questions were graded and then analyzed by ANOVA and Fisher's LSD test.

Results

After the online modules were completed, the intervention group residents’ mean score on knowledge questions was significantly higher than that prior to the curriculum and significantly higher than that the control group (previous graduated residents; 6.00 vs. 2.70, p = 0.0001; and 6.00 vs. 3.00, p = 0.0003, respectively). This score was maintained 3 months after completing the online modules. Intervention group residents were more satisfied with the online education resources than the control group (p = 0.048).

Conclusions

Residents participating in a formalized online curriculum during their teach month demonstrate a high comprehension of education concepts and increased satisfaction with the provided educational resources and report high satisfaction with the teach month. Our pilot study suggests that a short online education-focused curriculum is an effective method of providing RAT training and may be applicable to clinical teachers across specialties and experience levels.

导言：住院医师即教师（RAT）课程改善了住院医师参与者的教学行为、能力和信心。然而，关于合适的形式、长度和内容的数据却很有限。教学是住院医师的核心能力之一，住院医师在临床环境中承担了三分之一的学生教学任务，因此对住院医师进行适当的临床教学培训至关重要。我们创建了一个正式的、可扩展的异步 RAT 课程。我们报告了该课程的试点实施情况，以及可行性、用户接受度和初步知识成果。方法在这项试验性事后干预研究中，高年级急诊科住院医师在 "教学月 "期间完成了正式的在线教育课程。该课程由三个在线模块组成，每周完成一个为期四周的轮转。主题包括成人学习、评估和反馈以及小组教学。在课程实施前后，向住院医生发送了几份调查问卷。调查对满意度进行了评分，并提出了几个与教育相关的知识问题，以评估学习情况。评分采用平均值和置信区间（95%）进行分析。对知识问题进行评分，然后通过方差分析和费雪 LSD 检验进行分析。结果完成在线模块后，干预组住院医师在知识问题上的平均得分明显高于课程前的得分，且明显高于对照组（往届毕业住院医师；分别为 6.00 vs. 2.70，p = 0.0001；6.00 vs. 3.00，p = 0.0003）。在完成在线模块学习 3 个月后，该得分仍保持不变。干预组住院医师对在线教育资源的满意度高于对照组（p = 0.048）。结论在教学月期间参加正规化在线课程的住院医师对教育概念的理解能力较强，对所提供教育资源的满意度较高，并对教学月的满意度较高。我们的试点研究表明，以教育为重点的短期在线课程是提供 RAT 培训的有效方法，可能适用于不同专业和经验水平的临床教师。

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引用次数: 0

In reply to “Turning lemons into lemonade: Teaching strategies in boarded emergency departments.” 回复 "变柠檬为柠檬水：寄宿急诊科的教学策略"。

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-09 DOI: 10.1002/aet2.10933

Adam Heilmann MD

引用次数: 0

Understanding clerkship experiences in emergency medicine and their potential influence on specialty selection: A qualitative study 了解急诊医学实习经历及其对专业选择的潜在影响：定性研究

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-09 DOI: 10.1002/aet2.10932

Rosemarie Diaz MD, MPH, Sarah Balgord MD, Nicole Klekowski MD, Alexandra S. Farthing MD, MPH, Sylvia Guadalupe Escolero MD, Korynne DeCloux MD, John C. Burkhardt MD, PhD, Adrianne N. Haggins MD, MS, Laura R. Hopson MD

Objectives

The specialty of emergency medicine (EM) is experiencing a significant decrease in student interest. In addition, women are historically underrepresented within the specialty at all levels of training and practice. We sought to understand how clinical experiences and perceptions of EM influence specialty selection by medical students, particularly women.

Methods

Using a constructivist grounded theory approach, we analyzed semistructured interviews with senior medical students who considered EM as a specialty. We used purposive sampling to recruit from diverse learning environments and represent a variety of experiences. Participants reflected on their specialty selection process and experiences in EM including their perceived acceptance in the work environment.

Results

Twenty-five medical students from 11 geographically diverse schools participated. A total of 68% (17/25) identified as women. The majority (21/25, 84%) planned on applying to EM residency. We identified four major themes: (1) distressing interpersonal interactions with patients and the ED care team negatively affect students; (2) EM culture includes behaviors that are perceived as exclusionary; (3) beliefs about the attributes of an ideal EM physician and the specialty itself have a gendered nature; and (4) ease of access to mentors, representation, and early exposure to EM environment increased interest in specialty.

Conclusions

Our participants express that EM causes challenges for students to accept the norms of behavior in the field, which is an essential element in joining a group and professional identity formation. In addition, we raise concern that gendered perceptions and language may send exclusionary environmental cues that may negatively impact recruitment of a diverse physician workforce.

目标急诊医学（EM）专业的学生兴趣正在显著下降。此外，在该专业的各级培训和实践中，女性的比例历来偏低。我们试图了解临床经验和对急诊医学的认知如何影响医学生（尤其是女生）的专业选择。方法我们采用建构主义基础理论方法，分析了对考虑将电磁学作为一个专业的高年级医学生进行的半结构化访谈。我们采用有目的的抽样，从不同的学习环境中招募代表不同经历的学生。参与者对他们的专业选择过程和在 EM 的经历进行了反思，包括他们在工作环境中的接受程度。结果来自 11 所不同地区学校的 25 名医学生参加了调查。共有 68% 的学生（17/25）认为自己是女性。大多数学生（21/25，84%）计划申请成为急诊科住院医师。我们确定了四大主题：（1）与患者和急诊室护理团队之间令人苦恼的人际互动对学生产生了负面影响；（2）急诊室文化包括被认为具有排斥性的行为；（3）对理想急诊室医生的特质和该专业本身的信念具有性别特征；以及（4）容易接触导师、代表和早期接触急诊室环境提高了对该专业的兴趣。结论我们的参与者表示，电磁学给学生接受该领域的行为规范带来了挑战，而这是加入一个团体和形成职业认同的基本要素。此外，我们还担心，性别观念和语言可能会发出排斥性的环境暗示，从而对多元化医生队伍的招聘产生负面影响。

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引用次数: 0

Emergency medicine resident productivity across consecutive shifts 急诊科住院医师连续轮班的工作效率

IF 1.8 Q2 EDUCATION, SCIENTIFIC DISCIPLINES

AEM Education and Training

Pub Date : 2024-02-09 DOI: 10.1002/aet2.10935

Daniel L. Shaw MD, MCSO, Max S. Kravitz MD, Bryan A. Stenson MD, Jason J. Lewis MD, David T. Chiu MD, MPH

Objectives

Clinical productivity is an important operational and educational metric for emergency medicine (EM) residents. It is unclear whether working consecutive days and circadian disruption impact resident productivity. The objective of this study was to determine whether there is a correlation between consecutive shifts and productivity.

Methods

This was a single-site retrospective observational study using data from academic year 2021–2022 (July 1, 2021–June 23, 2022). Productivity was defined as primary resident encounters with patients per hour (PPH). Postgraduate year (PGY)-1 and PGY-2 productivity data and schedules were abstracted from the electronic medical record and scheduling software. Descriptive statistics, including arithmetic mean, standard deviation, and confidence interval (CI), were determined for each shift number and stratified by PGY level. Subgroup analysis of night shifts was performed. Analysis of variance and linear regression analysis were performed.

Results

A total of 2950 shifts were identified, including 1328 PGY-1 shifts and 1622 PGY-2 shifts, which involved a total of 32,379 patient encounters. PGY-1 residents saw a mean of 0.88–0.96 PPH on sequential shifts 1–7, respectively (y-intercept 0.923, slope 0.001, 95% CI −0.008 to 0.009, p = 0.86). PGY-2 residents saw a mean of 1.61–1.75 PPH on Shifts 1–7, respectively (y-intercept 1.628, slope 0.004, 95% CI –0.007 to 0.015, p = 0.50). A subgroup analysis of 598 overnight shifts (11 p.m.–7 a.m.) was performed, in which residents saw a mean of 1.29–1.56 PPH on Sequential Shifts 1–7 (y-intercept 1.286, slope 0.011, 95% CI −0.011 to 0.033, p = 0.34).

Conclusions

EM resident productivity remained relatively constant across consecutive shifts, including night shifts. These findings may have educational and operational implications. Further research is required to understand patient- and provider-oriented consequences of consecutive shift scheduling.

目的临床工作效率是急诊医学（EM）住院医师的一项重要业务和教育指标。目前尚不清楚连日工作和昼夜节律紊乱是否会影响住院医师的工作效率。本研究旨在确定连续轮班与工作效率之间是否存在相关性。方法这是一项单点回顾性观察研究，使用的数据来自 2021-2022 学年（2021 年 7 月 1 日至 2022 年 6 月 23 日）。生产率定义为住院医生每小时接诊病人的次数（PPH）。研究生年（PGY）-1 和 PGY-2 的生产率数据和日程安排是从电子病历和日程安排软件中提取的。对每个班次编号进行了描述性统计，包括算术平均数、标准差和置信区间 (CI)，并按研究生年级进行了分层。对夜班进行了分组分析。进行了方差分析和线性回归分析。结果共确定了 2950 个轮班，其中包括 1328 个 PGY-1 级轮班和 1622 个 PGY-2 级轮班，共接触了 32,379 名患者。PGY-1 级住院医师在 1-7 顺序轮班中平均发生 0.88-0.96 PPH（y-截距 0.923，斜率 0.001，95% CI -0.008-0.009，p = 0.86）。PGY-2 级住院医师在 1-7 班的平均 PPH 分别为 1.61-1.75 例（y-截距 1.628，斜率 0.004，95% CI -0.007 至 0.015，p = 0.50）。对 598 个夜班（晚上 11 点至早上 7 点）进行了分组分析，结果显示，住院医师在 1-7 顺序轮班中平均发生 1.29-1.56 PPH（y-截距 1.286，斜率 0.011，95% CI -0.011 至 0.033，p = 0.34）。结论急诊科住院医师的工作效率在包括夜班在内的连续班次中保持相对稳定。这些发现可能会对教育和操作产生影响。需要进一步研究以了解连续轮班安排对患者和医疗服务提供者的影响。

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