Monthly Progression of Emergency Medicine Resident Efficiency: What Can We Expect of Our Residents Throughout Training?

J Emerg Med. 2019 Jul;57(1):77-81. doi: 10.1016/j.jemermed.2019.03.037. Epub 2019 May 9.


Background: Developing the capacity for efficient patient care is essential during emergency medicine (EM) residency training. Previous studies have demonstrated that resident efficiency improves during each year of training.

Objectives: This study assessed the progression of EM resident efficiency monthly and sought to develop a model that describes this progression in terms of patients per hour (pts/h) weighted by month of training.

Methods: We performed a retrospective review of EM resident efficiency as determined by pts/h using EM resident monthly patient logs from a postgraduate year (PGY) 1-3 EM training program. Mean pts/h and standard deviation (SDs) were calculated based on month of training. One-way analysis of variance compared year-to-year training. We formulated several linear regression models to describe this progression.

Results: We analyzed 51 consecutive months of patient logs from 110 residents. The mean pts/h for PGY1 was 1.201 (n = 85, SD = 0.241), for PGY2 was 1.497 (n = 82, SD = 0.218), and for PGY3 was 1.676 (n = 80, SD = 0.224). Linear regression was used to describe patients seen per hour by the month of training. A significant regression was found with an R2 of 0.437 and p < 0.000. Over 36 months of training, a resident's predicted pts/h is equal to 1.113 + (0.018 × month of training).

Conclusions: EM resident efficiency increases monthly, with most improvement occurring in the PGY1 year. Understanding this improvement may aid in resident performance evaluation and the understanding of predicted resident workflow.

Keywords: education; efficiency; productivity; residency.

Publication types

  • Review

MeSH terms

  • Education, Medical, Graduate / methods
  • Education, Medical, Graduate / standards
  • Education, Medical, Graduate / statistics & numerical data
  • Efficiency*
  • Emergency Medicine / education
  • Emergency Medicine / standards*
  • Emergency Medicine / statistics & numerical data
  • Humans
  • Internship and Residency / standards*
  • Internship and Residency / statistics & numerical data
  • Retrospective Studies
  • Time Factors*
  • Time and Motion Studies