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{
    "pk": 10800,
    "title": "Experience Within the Emergency Department and Improved Productivity for First-Year Residents in Emergency Medicine and Other Specialties",
    "subtitle": null,
    "abstract": "Introduction:\n Resident productivity is an important educational and operational measure in emergency medicine (EM). The ability to continue effectively seeing new patients throughout a shift is fundamental to an emergency physician’s development, and residents are integral to the workforce of many academic emergency departments (ED). Our previous work has demonstrated that residents make gains in productivity over the course of intern year; however, it is unclear whether this is from experience as a physician in general on all rotations, or specific to experience in the ED.\nMethods:\n This was a retrospective cohort study, conducted in an urban academic hospital ED, with a three-year EM training program in which first-year residents see new patients ad libitum. We evaluated resident shifts for the total number of new patients seen. We constructed a generalized estimating equation to predict productivity, defined as the number of new patients seen per shift, as a function of the week of the academic year, the number of weeks spent in the ED, and their interaction. Off-service residents’ productivity in the ED was analyzed in a secondary analysis.\nResults:\n We evaluated 7,779 EM intern shifts from 7/1/2010 to 7/1/2016. Interns started at 7.16 (95% confidence interval [CI] [6.87 – 7.45]) patients per nine-hour shift, with an increase of 0.20 (95% CI [0.17 – 0.24]) patients per shift for each week in the ED, over 22 weeks, leading to 11.5 (95% CI [10.6 – 12.7]) patients per shift at the end of their training in the ED. The effects of the week of the academic year and its interaction with weeks in the ED were not significant. We evaluated 2,328 off-service intern shifts, in which off-service residents saw 5.43 (95% CI [5.02 – 5.84]) patients per nine-hour shift initially, with 0.46 additional patients per week in the ED (95% CI [0.25 – 0.68]). The weeks of the academic year were not significant.\nConclusion:\n Intern productivity in EM correlates with time spent training in the ED, and not with experience on other rotations. Accordingly, an EM intern’s productivity should be evaluated relative to their aggregate time in the ED, rather than the time in the academic year.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "productivity"
        },
        {
            "word": "operations"
        },
        {
            "word": "education"
        },
        {
            "word": "proficiency"
        }
    ],
    "section": "Original Research",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9xg4m3z2",
    "frozenauthors": [
        {
            "first_name": "Joshua",
            "middle_name": "W.",
            "last_name": "Joseph",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "T.",
            "last_name": "Chiu",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Matthew",
            "middle_name": "L.",
            "last_name": "Wong",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Carlo",
            "middle_name": "L.",
            "last_name": "Rosen",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Larry",
            "middle_name": "A.",
            "last_name": "Nathanson",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Leon",
            "middle_name": "D.",
            "last_name": "Sanchez",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts \nHarvard Medical School, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2017-05-09T17:09:13-07:00",
    "date_accepted": "2017-05-09T17:09:13-07:00",
    "date_published": "2017-12-14T08:54:20-08:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10800/galley/5880/download/"
        }
    ]
}