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{
    "pk": 19284,
    "title": "Teaching and Clinical Efficiency: Competing Demands",
    "subtitle": null,
    "abstract": "Introduction: Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times.\n \nMethods: The setting is an urban, academic emergency department with an annual census of 65,000patient visits. Previous analysis of an 18-question emergency medicine faculty survey at this institution identified 5 prevailing domains of faculty instructional performance. The 5 statistically significant domains identified were: Competency and Professionalism, Commitment to Knowledge and Instruction, Inclusion and Interaction, Patient Focus, and Openness and Enthusiasm. We fit a multivariate, random effects model using each of the 5 instructional domains for emergency medicine faculty as independent predictors and throughput time (in minutes) as the continuous outcome. Faculty that were absent for any portion of the research period were excluded as were patient encounters without direct resident involvement.\n \nResults: Two of the 5 instructional domains were found to significantly correlate with a change inpatient treatment times within both datasets. The greater a physician’s Commitment to Knowledge and Instruction, the longer their throughput time, with each interval increase on the domain scale associated with a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes). Conversely, increased Openness and Enthusiasm was associated with a 4.45-minute decrease in throughput (90% CI: 8.83 to 0.07 minutes).\n \nConclusion: Some aspects of teaching aptitude are associated with increased throughput times (Openness and Enthusiasm), while others are associated with decreased throughput times (Commitment to Knowledge and Instruction). Our findings suggest that a tradeoff may exist between operational and instructional performance. [West J Emerg Med. 2012;13(2):186–193.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 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\nNonCommercial — You may not use the material for commercial purposes.\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-nc/4.0"
    },
    "keywords": [
        {
            "word": "Residency Education"
        },
        {
            "word": "Pay for Performance"
        },
        {
            "word": "Patient flow"
        },
        {
            "word": "Instructional"
        },
        {
            "word": "Emergency Medicine"
        },
        {
            "word": "Medicine"
        }
    ],
    "section": "Emergency Department Administration",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2mp8424b",
    "frozenauthors": [
        {
            "first_name": "James",
            "middle_name": "E",
            "last_name": "Colletti",
            "name_suffix": "",
            "institution": "Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Thomas",
            "middle_name": "J.",
            "last_name": "Flottemesch",
            "name_suffix": "",
            "institution": "Regions Hospital, Department of Emergency Medicine, St Paul, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Tara",
            "middle_name": "",
            "last_name": "O'Connell",
            "name_suffix": "",
            "institution": "Hoag Hospital, Newport Beach, California",
            "department": "None"
        },
        {
            "first_name": "Felix",
            "middle_name": "K.",
            "last_name": "Ankel",
            "name_suffix": "",
            "institution": "Regions Hospital, Department of Emergency Medicine, St Paul, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Brent",
            "middle_name": "R.",
            "last_name": "Asplin",
            "name_suffix": "",
            "institution": "Fairview Medical Group, St Paul, Minnesota",
            "department": "None"
        }
    ],
    "date_submitted": "2011-06-27T21:02:17Z",
    "date_accepted": "2011-06-27T21:02:17Z",
    "date_published": "2012-05-03T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/19284/galley/9540/download/"
        }
    ]
}