Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Am J Emerg Med. 2010 Feb;28(2):217-20. doi: 10.1016/j.ajem.2008.10.030.
We studied if emergency department (ED) crowding affects the quality of resident and medical student education on individual patient encounters.
We performed a cross-sectional study of a ED faculty-learner interactions over a 5-week period in an academic ED. Research assistants administered surveys to residents and senior medical students assessing attending physicians on 4 domains (teaching, clinical care, approachability, and helpfulness) using a scale (ER score for teaching on individual patients) validated for use during ED rotations. Each domain was assessed on a 5-point scale with a highest score of 20 representing superb/outstanding. We tested the association between measures of ED crowding (waiting room number, occupancy, number of admitted patients, and patient-hours) at the time of assessment with the ER score and individual domain scores using correlation coefficients and regression analysis with clustering on the attending physician.
Forty-three residents (22 ED, 21 non-ED) and 3 medical students assessed 34 attending physicians in 352 separate encounters. Median ER score was 16/20 (interquartile range, 12-16). Emergency department crowding levels and ER scores on individual patients were not significantly correlated, nor were ED crowding and individual domains. In the adjusted analysis, ED crowding was not associated with an ER score of 16 or higher, nor was any ED crowding measure associated individual assessments of teaching, clinical care, approachability, or helpfulness.
Emergency department crowding is not associated with the quality of education on individual patients.
我们研究了急诊部（ED）拥堵是否会影响住院医师和医学生对个体患者的教育质量。
我们对一个学术 ED 中的 ED 教师-学习者互动进行了横断面研究，时间为 5 周。研究助理向住院医师和高年级医学生发放了调查问卷，评估主治医生在 4 个领域（教学、临床护理、亲和力和帮助）的表现，使用了一种在 ED 轮转期间验证的量表（ER 评分）。每个领域都用 5 分制进行评估，最高得分为 20 分，表示优秀/出色。我们使用相关系数和回归分析，对评估时的 ED 拥堵（候诊室人数、占有率、住院人数和患者就诊时间）与 ER 评分和个别领域评分进行了测试，同时对主治医生进行了聚类分析。
43 名住院医师（22 名 ED，21 名非 ED）和 3 名医学生评估了 352 次单独就诊的 34 名主治医生。ER 评分中位数为 16/20（四分位距，12-16）。ED 拥堵程度和个体患者的 ER 评分之间没有显著相关性，ED 拥堵与各个领域之间也没有相关性。在调整后的分析中，ED 拥堵与 ER 评分达到 16 或更高无关，ED 拥堵的任何指标也与教学、临床护理、亲和力或帮助的个别评估无关。
ED 拥堵与个体患者的教育质量无关。
