Results
The total number of shifts for each group and the breakdown of the shifts worked were not equal among the study groups. EM2 residents worked the greatest number of shifts (380), followed by the EM1 (205), IM1 (179), and IM2 (172) groups. The breakdown of shift times was likewise unequal, reflecting an administrative mandate that an EM2 be scheduled for every shift and the preference for either an EM1 or IM2 resident (but not an IM1 resident) to work overnight shifts. EM2 residents primarily evaluated 4114 patients during the study months–more patients than any other group–followed by the EM1, IM2, and IM1 groups ( Table 1 ).
Over the course of the academic year, EM1 residents experienced a significant increase in the number of patients seen per shift. In July, they saw a mean of 6.3 patients per shift, but by June this had increased to 10.3 patients per shift (p < 0.0001). None of the other groups had a significant increase in productivity as the year progressed. EM1 and IM2 groups begin the academic year with similar productivity rates (EM1 6.3 patients/shift; IM2 6.38 patients/shift) but separate through the year. IM residents start at 3.9 patients per shift and show a nonsignificant trend toward increased productivity as the year progresses (Figure 1).
(Enlarge Image)
Figure 1.
Resident productivity per month, based on the number of patients per shift between July 2009 and April 2010. EM1 (p < 0.0001), EM2 (p = 0.7366), IM1 (p = 0.4918), and IM2 (p = 1.0000). EM = emergency medicine; IM = internal medicine.
Overall, EM2 residents admitted 60% of their patients, compared with 50% of patients seen by IM2, 49% for EM1, and 47% for IM1 residents. Overall, there was no significant difference in the admission rates for any study month for the entire ED. A significant difference in admission rates was not present among EM1, IM1, and IM2 groups. A significant difference was present in the admission rates among shifts, with the 3 pm–11 pm shift having the highest admission rate (59%) and the 11 pm–7 am shift having the lowest admission rate (43%; Table 2 ).