The effects of clinical workload on teaching in the emergency department.

BACKGROUND: Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching.

OBJECTIVES: To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED).

METHODS: This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten-point scales. A linear mixed-effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies.

RESULTS: No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (beta estimate, 0.024; p = 0.55), attending physicians' workload perception (beta estimate, -0.05; p = 0.28), patient volume in patients per hour (beta estimate, -0.010; p = 0.36), and shift type (beta estimate, -0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (beta estimate, 0.12; p = 0.005), clinical teaching skills (beta estimate, 0.36; p < 0.001), willingness to teach (beta estimate, 0.25; p < 0.001), and interpersonal skills (beta estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (beta estimate, 0.007; p = 0.35).

CONCLUSIONS: Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were.