title: How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?
abstract: BACKGROUND
  The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education.
  
  
  OBJECTIVE
  To determine whether ED crowding, as measured by the National ED Overcrowding Scale (NEDOCS) score, has a quantifiable effect on medical student objective and subjective experiences during emergency medicine (EM) clerkship rotations.
  
  
  METHODS
  We collected end-of-rotation examinations and medical student evaluations for 21 EM rotation blocks between July 2010 and May 2012, with a total of 211 students. NEDOCS scores were calculated for each corresponding period. Weighted regression analyses examined the correlation between components of the medical student evaluation, student test scores, and the NEDOCS score for each period.
  
  
  RESULTS
  When all 21 rotations are included in the analysis, NEDOCS scores showed a negative correlation with medical student tests scores (regression coefficient= -0.16, p=0.04) and three elements of the rotation evaluation (attending teaching, communication, and systems-based practice; p<0.05). We excluded an outlying NEDOCS score from the analysis and obtained similar results. When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011). No part of the medical student rotation evaluation attained significant correlation with the NEDOCS score (p≥0.34 in all cases).
  
  
  CONCLUSIONS
  ED overcrowding does demonstrate a small but negative association with medical student performance on end-of-rotation examinations. Additional studies are recommended to further evaluate this effect.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
authors.forename: Grant
authors.initials: G
authors.lastname: Wei
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Arya
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
authors.forename: Z Trevor
authors.initials: ZT
authors.lastname: Ritz
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
authors.forename: Albert S
authors.initials: AS
authors.lastname: He
authors.affiliation: Rutgers School of Public Health, Department of Biostatistics, New Brunswick, New Jersey.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ohman-Strickland
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey.
authors.forename: Jonathan V
authors.initials: JV
authors.lastname: McCoy
mesh_terms: D002982:Clinical Clerkship / Q000592:standards* / Q000706:statistics & numerical data; D003441:Crowding / Q000523:psychology*; D004521:Educational Measurement / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009515:New Jersey; D010549:Personal Satisfaction; D013337:Students, Medical / Q000523:psychology*