Authors
Jake Valentine, Jonathan Poulson, Jesus Tamayo, Amanda Valentine, Jacqueline Levesque, Shane Jenks
Source
Western Journal of Emergency Medicine, 2024
Conclusion
This review indicates that residents can boost ED productivity, while medical students do not have a significant impact. However, both groups are associated with a minor reduction in efficiency. The evidence quality was generally low, suggesting that the observed decreases in efficiency are small and may not be of meaningful clinical relevance. Nevertheless, residents provide a financial benefit through increased revenue generation. This suggests that the involvement of medical trainees in the ED can serve complementary roles rather than competing ones, supporting their inclusion in clinical practice sites.
Methods
A comprehensive search of PubMed, Embase, Scopus, and Web of Science databases was conducted up to March 2023. The study included research evaluating the effects of medical students and/or residents on ED productivity and efficiency metrics. Only U.S.-based studies were included. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool. The certainty of the evidence was evaluated using the GRADE approach. Findings were synthesized narratively according to PRISMA guidelines.
Results
- Search and Study Selection: Of the 3,390 unique articles identified, 81 abstracts were considered relevant. Full texts were retrieved for 76 articles, and 13 were included in the final systematic review.
- Study Design: The studies were nearly equally split between observational (6) and quasi-experimental (7) designs. Most studies (11) were conducted at single sites. Only two studies had a low risk of bias.
- Productivity and Efficiency:
- Residents: Moderate increase in productivity, contributing to increased revenue by generating an additional $26.30 per hour in relative value units (RVUs).
- Medical Students: Did not significantly impact ED productivity.
- Efficiency: Both students and residents were associated with a slight decrease in ED efficiency, but the effect size was statistically small and of debatable clinical significance.