title: The effects of clinical workload on teaching in the emergency department.
abstract: BACKGROUND
  Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. skelly2@bidmc.harvard.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Kelly
authors.forename: Nathan
authors.initials: N
authors.lastname: Shapiro
authors.forename: Michael
authors.initials: M
authors.lastname: Woodruff
authors.forename: Kelly
authors.initials: K
authors.lastname: Corrigan
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001900:Boston; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016526:Workload