Emergency medicine (EM) faculty physicians are often challenged to develop clinical experiences that meet patients’ needs as well as trainees’ educational requirements during residency. EM residency programs need to take full advantage of the limited amount of time they have to teach physicians-in-training. Few studies have examined the effect of academic ED physician staffing models on the attitudes and perceptions of residents.
A New Model
In 2012, the EM residency program at the University of Maryland adopted a new physician staffing model. The previous model included two faculty physicians, one senior resident, two interns, and one “swing” resident. In this model, the attending physicians were confined geographically while residents and interns were alternately assigned patients. This made it challenging for nurses to identify which physicians were caring for each individual patient. The learning environment was also less conducive to individualized instruction.
The staffing model was redesigned after receiving input from residents, nursing staff, and faculty physicians to take a more team-based approach. The ED was divided geographically between two teams, with each consisting of an attending physician, an upper-level resident, and an intern. In the team-based model, upper-level residents were paired with a single attending and intern throughout an entire shift.
In a study published in the Western Journal of Emergency Medicine, Jose V. Nable, MD and colleagues described their experience after adopting the team-based physician staffing model. “The new model improved residents’ perceptions about their educational experience,” says Dr. Nable, who was co-chief resident of the program when the study was conducted. “Residents saw a higher volume of patients during their shifts because they were given a large and specific geographic responsibility within the ED. This reduced confusion relating to patient assignments during busy clinical shifts.”
The team-based model provided an opportunity to share tasks, such as arranging follow-up, calling consults, and documenting patient care. “The option for shared responsibilities appeared to enhance perceptions of the clinical experience,” Dr. Nable says. “It allowed for a higher-degree of interaction between faculty physicians and residents, which increased teaching efficiency.” The team-based model was also associated with more patient evaluations when compared with the previous staffing model in which “swing” residents could self-select their patients.
More to Come
EM residents value participation in the work environment, focused learning moments, repetitive teaching cycles, and intense learning experiences. Dr. Nable says more information is needed on ideal staffing models, but notes that this will require more research because all EDs are different. “Our study demonstrated that team-based models can improve efficiency and the learning experience for residents,” he says. “Our findings may help with the development of academic ED physician staffing models to further improve the teaching environment and perhaps enhance patient outcomes.”
Readings & Resources (click to view)
Nable JV, Greenwood JC, Abraham MK, Bond MC, Winters ME. Implementation of a team-based physician staffing model at an academic emergency department. West J Emerg Med. 2014 May 29 [Epub ahead of print]. Available at: http://escholarship.org/uc/item/4qg5v0ck#page-1 or at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162729/.
Bandiera G, Lee S, Tiberius R. Creating effective learning in today’s emergency departments: how accomplished teachers get it done. Ann Emerg Med. 2005;45:253-261.
Wrenn K, Lorenzen B, Jones I, et al. Factors affecting stress in emergency medicine residents while working in the ED. Am J Emerg Med. 2010;28:897-902.
Penciner R. Clinical teaching in a busy emergency department: strategies for success. CJEM. 2002;4:286-288.
Kelly SP, Shapiro N, Woodruff M, et al. The effects of clinical workload on teaching in the emergency department. Acad Emerg Med. 2007;14:526-531.