An evaluation of emergency medicine resident interaction time with faculty in different teaching venues.
OBJECTIVE
To measure actual emergency medicine (EM) resident interaction time with faculty and to investigate the potential to use direct observation as an assessment tool for the core competencies. By 2006 all EM residencies must implement resident assessment techniques of the six Accreditation Council for Graduate Medical Education core competencies. Emergency medicine educators recommend direct observation as the optimal evaluation tool for patient care, systems-based practice, interpersonal and communication skills, and professionalism. Continuous faculty presence in the emergency department (ED) is widely believed to facilitate direct observation as an assessment technique.


METHODS
Observational study of EM resident-faculty interaction time during two-hour periods. Study venues included two EDs, two trauma services, inpatient medicine, adult and pediatric intensive care units (ICUs), and a pediatric outpatient clinic. Using a priori definitions, the authors categorized faculty-EM resident interaction time as direct observation of patient care, indirect patient care, or non-patient care activities, and calculated total faculty interaction time. Subjects were blinded to the nature of the study, and data gathering was encrypted.


RESULTS
Two hundred seventy observation periods of two hours each were conducted, sampling 32 EMR1, 33 EMR2-3, 41 EM, and 38 non-EM faculty. The mean total faculty interaction time ranged from a high of 30% (95% CI = 20% to 41%) in the pediatric ICU to a low of 10% (95% CI = 3% to 16%) on internal medicine wards. Overall, EM faculty interaction time was 20% (95% CI = 18% to 22%). Direct observation by faculty ranged from a high of 6% for EMR2-3s in the critical care areas of the ED (95% CI = 3% to 9%) to a low of 1% (95% CI = 0% to 2%) on internal medicine wards. Overall ED direct observation time was 3.6% (95% CI = 2.6% to 4.7%). Emergency department direct observation did not vary within EM resident training level or by ED site. Direct observation varied by treatment area within the EDs, with the critical care areas being substantially higher (6%) than the noncritical care areas (1%).


CONCLUSIONS
Faculty direct observation time of EM residents was low in all training venues studied. Direct observation was the highest in ED critical care areas and lowest on medicine ward rotations. Emergency medicine faculty involved simultaneously in routine ED teaching, supervision, and patient care rarely performed direct observation, despite their continuous physical presence. This finding suggests that alternative strategies may be required to assess core competencies through direct observation in the ED.
Chisholm
Carey D
CD
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA. cchisholm@clarian.org
Whenmouth
Laura F
LF
Daly
Elizabeth A
EA
Cordell
William H
WH
Giles
Beverly K
BK
Brizendine
Edward J
EJ
D004635:Emergency Medicine / Q000193:education* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005180:Faculty, Medical / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000193:education / Q000458:organization & administration / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data*; D007400:Interprofessional Relations; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education / Q000706:statistics & numerical data; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000706:statistics & numerical data