title: Implementation of a team-based physician staffing model at an academic emergency department.
abstract: BACKGROUND
  There is scant literature regarding the optimal resident physician staffing model of academic emergency departments (ED) that maximizes learning opportunities. A department of emergency medicine at a large inner-city academic hospital initiated a team-based staffing model. Its pre-interventional staffing model consisted of residents and attending physicians being separately assigned patients, resulting in residents working with two different faculty providers in the same shift. This study aimed to determine if the post-interventional team-based system, in which residents were paired with a single attending on each shift, would result in improved residents' learning and clinical experiences as manifested by resident evaluations and the number of patients seen.
  
  
  METHODS
  This retrospective before-and-after study at an academic ED with an annual volume of 52,000 patients examined the mean differences in five-point Likert-scale evaluations completed by residents assessing their ED rotation experiences in both the original and team-based staffing models. The residents were queried on their perceptions of feeling part of the team, decision-making autonomy, clinical experience, amount of supervision, quality of teaching, and overall rotational experience. We also analyzed the number of patients seen per hour by residents. Paired sample t-tests were performed. Residents who were in the program in the year preceding and proceeding the intervention were eligible for inclusion.
  
  
  RESULTS
  34 of 38 eligible residents were included (4 excluded for lack of evaluations in either the pre- or post-intervention period). There was a statistically significant improvement in resident perception of the quality and amount of teaching, 4.03 to 4.27 (mean difference=0.24, p=0.03). There were non-statistically significant trends toward improved mean scores for all other queries. Residents also saw more patients following the initiation of the team-based model, 1.24 to 1.56 patients per hour (mean difference=0.32, p=0.0005).
  
  
  CONCLUSIONS
  Adopting a team-based physician staffing model is associated with improved resident perceptions of quality and amount of teaching. Residents also experience a greater number of patient evaluations in a team-based model.
authors.affiliation: University of Maryland Baltimore County, Department of Emergency Health Services, Baltimore, Maryland ; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Jose V
authors.initials: JV
authors.lastname: Nable
authors.affiliation: University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: John C
authors.initials: JC
authors.lastname: Greenwood
authors.affiliation: University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Abraham
authors.affiliation: University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Bond
authors.affiliation: University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Winters
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D016730:Program Development; D000078329:Workforce