A Comparison of Faculty Contact Time with Emergency Medicine Residents in Different Teaching Venues

• Published in: Academic emergency medicine Vol. 10; no. 5; p. 472
• Main Author: Chisholm, C. D
• Format: Journal Article
• Language: English
• Published: Des Plaines Wiley Subscription Services, Inc 01.05.2003
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.472

OBJECTIVE: Emergency Medicine (EM) residencies must implement the 6 ACGME core competencies by 2006. EM educators recommend direct observation (DO) as the optimal evaluation tool for 4 of the 6 core competencies (Patient Care, Systems-Based Practice, Interpersonal and Communication Skills, and Professionalism). The 24/7 faculty presence in the Emergency Department (ED) is believed to facilitate DO as an assessment technique. METHODS: Observational study of faculty contact in 2 EDs, 2 trauma services, inpatient medicine, adult & pediatric ICUs, and a pediatric outpatient clinic (UVC). Faculty contact was categorized as DO of patient care, indirect patient care, or non-patient care activities using a priori definitions. EM residents were shadowed for 2-hour intervals. Subjects were blinded to the nature of the study and data gathering was encrypted. RESULTS: 270 observation periods of 2 hours each were conducted, sampling 32 EM R1, 33 EM R2-3, 41 EM and 38 non-EM faculty. Total faculty contact time ranged from a maximum of 30% (95% CI = 20, 41) in the pediatric ICU to a minimum of 10% (3, 16) on internal medicine wards. Overall ED faculty contact was 20% (18, 22). DO by faculty ranged from a high of 5% (3, 8) in the pediatric UVC to a low of 1% (0, 2) on internal medicine wards. Overall ED DO was 3.6% (2.6, 4.7). ED DO did not vary across EMR level or by site. DO varied by treatment area within the ED with the critical area being substantially higher (6%) when compared with the non-critical care areas (1%). CONCLUSIONS: Direct observation of EM residents was low in all training venues studied. Overall DO was the highest in ED critical care areas and lowest on medicine ward rotations. EM faculty who are already involved in routine teaching, supervision, and patient care rarely performed DO in spite of their immediate physical presence 24/7. This suggests that alternative strategies may be required to assess core competencies through direct observation in the Emergency Department.