PGY-2 emergency medicine residents are more efficient when paired with an early clinical medical student

Objectives

There is a concern that provide increased extraneous cognitive load when paired with residents on shift. However, this may be offset by the decrease in extraneous load they may provide to the residents they are paired with by offloading basic patient care tasks. We hypothesized that these forces may not be balanced.

Methods

We conducted a retrospective observational analysis of PGY-2 emergency medicine residents and junior medical students at a single academic emergency department (ED) in the Midwest. A series of efficiency metrics (relative value unit [RVUs], patients per hour [PPH], time to note completion, and resident assignment to disposition [RATD]) as well as one quality metric (number of return ED visits; “bouncebacks”) were compared for resident shifts in which a student was paired with the resident as well those in which no student was paired utilizing a regression model.

Results

A total of 1844 records met the inclusion criteria (214 shifts with a paired medical student and 1630 without). After covariates were adjusted for, medical student shift status was a statistically significant predictor of increases in PPH (p < 0.0001) and RVUs (p = 0.0161) but was not significantly associated with RATD (p = 0.6941), log-time to note completion (p = 0.1604), or bounceback status (p = 0.9840). Shifts where residents were paired with medical students were predicted to see an additional 1.131 (95% confidence interval [CI] 0.660–1.602) PPH and produce an additional 1.923 RVUs (95% CI 1.130–3.273) per shift relative to shifts without medical students.

Conclusions

When junior medical students were paired with a PGY-2 resident on ED shifts, there was a significant increase in the PPH and RVUs generated when compared with shifts in which no medical student was paired with them.