تاثیر مدل آموزشی اقامت پزشکی بر بهره وری بخش اورژانس در یک مرکز دانشگاهی

The residency teaching model is often cited as a source of inefficiency in the healthcare system. We build a simulation model of an Emergency Department (ED) at a large urban academic hospital. Using historical data and a natural experiment involving residents in the ED, we show that residents in fact increase throughput and lower service and waiting times compared to not being there at all.

The rising cost of healthcare is of significant social and political concern in America today. According to the Center for Medicare and Medicaid services (CMS), in 2007, total healthcare spending in the USA was $2.2 trillion. At $7421 per person, this accounts for over 16% of the nation's GDP. By 2007, healthcare spending was more than three times what it had been in 1990 [16]. CMS expects that healthcare spending will keep increasing at 6% per year until 2018, at which point it will account for a fifth of the United States economy. While there are many components to these costs, hospitals contributed the largest amount, at 32% of all healthcare expenditures. Increasing hospital efficiency is one way to help slow the growth of healthcare spending. [7] reports that total healthcare spending increased to $2.5 trillion or $8047 per person, by 2009. One potential source of inefficiency that we will study in this paper is the residency teaching model. After students graduate from medical school, they must complete three to seven years of additional training under a senior doctor, called an attending physician, to become board certified in a medical or surgical specialty. Residencies can be completed in any general or specialty field within medicine or surgery. Upon successful completion of residency and the specific medical boards for that specialty, a doctor is then considered a certified specialist. This level of training is required to work as an attending physician in an academic center. While working as a resident, a new doctor will diagnose and treat patients under the supervision of an attending physician who oversees and teaches the residents, while providing clinical care. It is a common hypothesis that the presence of residents in a hospital setting hinders overall system efficiency [5]. Because attending physicians have to spend time teaching residents that could be spent treating patients directly, it has been suggested that residents slow down treatment and hinder efficiency. We worked with the University of Maryland Medical Center (UMMC) to help determine the impact of their residency teaching model on efficiency in the Emergency Department (ED). We collected data and designed and implemented a simulation model of the ED. In Section 2, we review the relevant literature. In Section 3, we discuss our data and provide a detailed description of the simulation model. Validation of the model is given in Section 4. In Section 5, we discuss the results and implications. The conclusions are presented in Section 6.

A common hypothesis in the medical community is that residents slow down treatment in EDs and have a negative impact on system efficiency, compared to just attending physicians. This paper has shown that, to the contrary, residents have a positive effect on throughput and treatment times. In particular, we found that, when treating high-severity patients, residents help to decrease waiting times, decrease treatment times, and increase throughput. While efficiency might not be a main concern in deciding which patients are seen by residents, we would recommend that they see as many high-severity patients as is feasible. This fits with the mission of the ED residency program. Furthermore, since residents cannot work as many hours per week as in the past, it is important for them to use their time wisely and productively. The main contribution of this paper is to provide evidence refuting the hypothesis that residents slow down progress in the ED and that they have a negative effect on efficiency.