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Emergency department crowding: the effect on resident education

Atzema C, Bandiera G, Schull MJ, Coon TP, Milling TJ. Ann Emerg Med. 2005; 45(3):276-81.


A recent study analyzed the amount of time emergency medicine residents spend with their faculty supervisors when they work together in the emergency department (ED). The authors found that attending physicians observed the resident providing direct patient care during only 3% of the resident's total work time. This is consistent with a previous report and occurred in a setting of one resident working with one attending physician. Indirect observation, including tasks such as presenting patient information, constituted another 11% of the resident's work time. The authors questioned whether observation time could be increased by faculty education or whether faculty were already at their capacity. They recommended that administrators who develop resident assessment techniques be cognizant of the time limitations faculty have while working clinically in the ED.

We suspect that these “time limitations” are caused in part by ED crowding. Many EDs are struggling with increased patient volumes and worsened crowding; words like “gridlock,” “boarded,” “holding time,” and “trolley waits” have become part of the lexicon of emergency medicine in a variety of countries. In the United States, ED crowding became more prominent in the early 1990s, at teaching centers; by the late 1990s, it was reported in community, suburban, and rural hospitals. ED crowding has also been documented in Canada, the United Kingdom, Spain, Australia, and Taiwan, using a variety of techniques and definitions. Numerous causes have been postulated and investigated. As ED crowding threatens to shift from a discussion point to a part of ED practice, it is timely to examine the likely effect it has on emergency medicine residency education.

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Keywords: Medical education and training Emergency medical services

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