Hill Jeffery, Hickam Grace, Shaw Jazmyn, Moll Joel, Cyrus John W, Santen Sally A, Gottlieb Michael
University of Cincinnati Cincinnati Ohio USA.
Virginia Commonwealth University Richmond Virginia USA.
AEM Educ Train. 2025 May 13;9(3):e70040. doi: 10.1002/aet2.70040. eCollection 2025 Jun.
Emergency department (ED) overcrowding and boarding has been shown to have negative effects on patient care. However, there has been less focus on the effects of overcrowding and boarding on resident education.
We conducted a scoping review to map the current literature on the educational effects of ED overcrowding, summarizing the current research findings and identifying gaps for future research. We sought to answer (1) How is overcrowding defined by individual studies? (2) What educational outcomes have been studied in overcrowding and how have they been measured? (3) What are the educational effects of physician-in-triage (PIT) care models? (4) What educational responses have been initiated in response to ED overcrowding? and (5) What are the effects of those educational responses? We searched Medline, Embase, ERIC, MedEdPortal, Web of Science, and Google Scholar. Two authors independently extracted data. All authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews.
The initial search strategy identified 2570 articles, with 14 articles meeting inclusion criteria. The literature found perceptions of a negative impact of overcrowding and boarding on resident education. However, these negative perceptions have not consistently translated to demonstrably negative educational outcomes. Educational outcomes assessed include measures of resident productivity, procedural experience, in-training examination scores, and perceived measures of teaching quality and educational value. Several studies assessed the impact of PIT models finding changes in the type and volume of patients seen by residents as a result.
This scoping review summarizes the existing literature assessing the educational impact of ED overcrowding and boarding as well as PIT models. The review provides context and insights for future research into these effects.
急诊科过度拥挤和滞留已被证明会对患者护理产生负面影响。然而，对于过度拥挤和滞留对住院医师教育的影响关注较少。
我们进行了一项范围综述，以梳理当前关于急诊科过度拥挤教育影响的文献，总结当前研究结果并确定未来研究的空白。我们试图回答以下问题：（1）各项研究如何定义过度拥挤？（2）在过度拥挤方面研究了哪些教育结果，以及如何进行测量？（3）医师分诊（PIT）护理模式的教育效果如何？（4）针对急诊科过度拥挤采取了哪些教育应对措施？（5）这些教育应对措施的效果如何？我们检索了医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）、教育资源信息中心（ERIC）、医学教育门户网站（MedEdPortal）、科学引文索引（Web of Science）和谷歌学术。两位作者独立提取数据。所有作者进行了定量和定性综合分析，符合范围综述的最佳实践建议。
初步检索策略共识别出2570篇文章，其中14篇符合纳入标准。文献发现，人们认为过度拥挤和滞留对住院医师教育有负面影响。然而，这些负面看法并未始终转化为明显的负面教育结果。评估的教育结果包括住院医师生产力指标、操作经验、在职考试成绩以及对教学质量和教育价值的感知指标。多项研究评估了PIT模式的影响，结果发现住院医师所见患者的类型和数量发生了变化。
本范围综述总结了现有评估急诊科过度拥挤和滞留以及PIT模式教育影响的文献。该综述为未来对这些影响的研究提供了背景和见解。
