title: An evaluation of resident work profiles, attending-resident teaching interactions, and the effect of variations in emergency department volume on each.
abstract: OBJECTIVE
  This study examines the effect of variations in emergency department (ED) volume on physician work efficiency (new patients per hour) and work profile (patient-related activities, including both direct and indirect patient care) and whether these differ between first- (Postgraduate Year [PGY]1) and third- (PGY3) year residents. The authors also determine if changes in volume are associated with changes in teaching interactions between attending and resident physicians.
  
  
  METHODS
  This was a prospective observational study of resident and attending physicians in the ED. Research assistants (RAs) followed ED residents during clinical shifts and recorded a multitude of data including the amount of time spent in specific activities, the number of new patients seen, and the frequency of attending physician teaching interactions.
  
  
  RESULTS
  Third-year residents see more new patients per hour (1.79 vs. 1.16, p < 0.001) than do their first-year counterparts. In addition, third-year residents spend almost 50% less time with each patient (10.7 minutes vs. 19.4 minutes, p < 0.001), and first-year residents spend three times as much time per shift discussing patients with attending physicians (59.4 minutes vs. 27.3 minutes, p = 0.002). More of the PGY1/attending interactions resulted in educational exchanges (54.9% vs. 34.6%, p = 0.003). PGY1 residents also spend more time on dictations per patient (9.6 minutes vs. 5.4 minutes, p = 0.01) and more time on paperwork per patient (18.5 minutes vs. 6.5 minutes, p = 0.007). As ED volume tripled, PGY1 residents were able to increase their patient load to a greater extent than were PGY3 residents by decreasing the length of each patient encounter as volume increased. Overall, ED volume had no effect on the number of teaching interactions, although the length of exchange decreased as volume increased.
  
  
  CONCLUSIONS
  Third-year residents see and carry more patients than do their first-year counterparts. They do so primarily by decreasing the amount of time spent with patients and attendings and working more efficiently overall. However, they are not as capable of altering their work profiles in the face of increased volume as their first-year counterparts. While the length of teaching interactions is decreased as volume increases, the number of those interactions resulting in teaching remains constant regardless of volume.
authors.affiliation: Department of Emergency Medicine, Albany Medical College, Albany, NY, USA. thibodl@mail.amc.edu
authors.forename: Lorraine G
authors.initials: LG
authors.lastname: Thibodeau
authors.forename: Sean P
authors.initials: SP
authors.lastname: Geary
authors.forename: Christopher
authors.initials: C
authors.lastname: Werter
mesh_terms: D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital; D019370:Observation; D011446:Prospective Studies; D013663:Teaching / Q000379:methods*; D014481:United States; D014938:Work Capacity Evaluation; D016526:Workload