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{
    "pk": 13577,
    "title": "Documentation Displaces Teaching in an Academic Emergency Department",
    "subtitle": null,
    "abstract": "Introduction:\n Adverse effects of administrative burden on emergency physicians have been described previously, but the impact of electronic health record documentation by academic emergency attendings on resident education is not known. In this observational study of a quaternary care, academic emergency department, we sought to assess whether the amount of time attending physicians spent on documentation affected the amount of time they spent teaching.\nMethods:\n A fourth-year emergency medicine (EM) resident observed 10 attending physicians over 42 hours during 11 shifts, recording their activities every 30 seconds. Activity categories were developed iteratively by the study team and validated through co-observation by an EM education fellow with a kappa of 0.89. We used regression analysis to assess the relationship between time spent documenting and time spent teaching, as well as the relationship between these two activities and all other attending activity categories.\nResults:\n Results demonstrate that time spent documenting was significantly and specifically associated with less time spent teaching, controlling for patient arrivals per hour; every minute spent on documentation was associated with 0.48 fewer minutes spent teaching (p<0.05). Further, documentation time was not strongly associated with time spent on any other activity including patient care, nor did any other activity significantly predict teaching time.\nConclusion:\n Findings suggest that academic attendings may face a trade-off between their documentation and teaching duties. Further study is needed to explore how administrative expectations placed on academic emergency physicians might interfere with trainee education.",
    "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": "Documentation, education, administrative burden, on-shift teaching"
        }
    ],
    "section": "Education",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/93x523k5",
    "frozenauthors": [
        {
            "first_name": "Joshua",
            "middle_name": "J.",
            "last_name": "Baugh",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Derek",
            "middle_name": "L.",
            "last_name": "Monette",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "James",
            "middle_name": "K.",
            "last_name": "Takayesu",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Ali",
            "middle_name": "S.",
            "last_name": "Raja",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "J.",
            "last_name": "Yun",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2020-02-15T05:26:42+05:30",
    "date_accepted": "2020-02-15T05:26:42+05:30",
    "date_published": "2020-06-16T01:03:39+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/13577/galley/7102/download/"
        }
    ]
}