title: Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.
abstract: BACKGROUND
  Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation.
  
  
  METHODS
  In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013.
  
  
  RESULTS
  The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p < 0.001) and 5.7(SD 2.0) in FY2015 (p < 0.001). A higher proportion of residents reported "just right" patient volume (64.4%, 91.7%, 96.7% in FY2013, 2014, 2015 respectively p < 0.001), meeting curricular goals (79.9%, 95.0%, 97.2%, in FY2013, 2014 and 2015 respectively p < 0.001), and overall educational value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p < 0.001).
  
  
  CONCLUSIONS
  Decreasing resident workload through adding clinical faculty (both staff physician and APPs) was associated with improvements on resident perceived educational value and clinical experience of a medical consultation rotation.
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. michele.fang@uphs.upenn.edu.|Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. michele.fang@uphs.upenn.edu.|Section of Hospital Medicine, Hospital of the University of Pennsylvania, Department of Medicine, Section of Hospital Medicine, 3400 Spruce Street, Maloney Building, 5th floor, Suite 5033, Philadelphia, PA, 19104, USA. michele.fang@uphs.upenn.edu.
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0003-4028-9489
authors.initials: M
authors.lastname: Fang
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Linson
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Suneja
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Ethan F
authors.initials: EF
authors.lastname: Kuperman
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards; D005221:Fatigue; D006801:Humans; D007396:Internship and Residency; D007484:Iowa; D007588:Job Satisfaction; D010549:Personal Satisfaction; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000592:standards; D014940:Work Schedule Tolerance / Q000523:psychology*; D016526:Workload / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Graduate medical education; Internal medicine; Internship and residency; Nurse practitioners; Preoperative care; Workload