Monthly Progression of Emergency Medicine Resident Efficiency: What Can We Expect of Our Residents Throughout Training?

BACKGROUND: Developing the capacity for efficient patient care is essential during emergency medicine (EM) residency training. Previous studies have demonstrated that resident efficiency improves during each year of training.

OBJECTIVES: This study assessed the progression of EM resident efficiency monthly and sought to develop a model that describes this progression in terms of patients per hour (pts/h) weighted by month of training.

METHODS: We performed a retrospective review of EM resident efficiency as determined by pts/h using EM resident monthly patient logs from a postgraduate year (PGY) 1-3 EM training program. Mean pts/h and standard deviation (SDs) were calculated based on month of training. One-way analysis of variance compared year-to-year training. We formulated several linear regression models to describe this progression.

RESULTS: We analyzed 51 consecutive months of patient logs from 110 residents. The mean pts/h for PGY1 was 1.201 (n = 85, SD = 0.241), for PGY2 was 1.497 (n = 82, SD = 0.218), and for PGY3 was 1.676 (n = 80, SD = 0.224). Linear regression was used to describe patients seen per hour by the month of training. A significant regression was found with an R2 of 0.437 and p < 0.000. Over 36 months of training, a resident's predicted pts/h is equal to 1.113 + (0.018 × month of training).

CONCLUSIONS: EM resident efficiency increases monthly, with most improvement occurring in the PGY1 year. Understanding this improvement may aid in resident performance evaluation and the understanding of predicted resident workflow.