Valerie is always irked by the layman’s expression, “Those who can’t do, teach.” In her experience, she has found that the great clinical teachers seem to be more engaged in the academic community and are invested in patient education. Indeed, Valerie finds that any additional time they spend with students or patients is well worth it. On the other hand, her friend Hugo points out that this extra time spent means the teachers aren’t as “fast” as others, which disrupts departmental flow. Whose side does the data support? Is this a false dichotomy?
Every physician knows the demands of time constraints. Taking care of patients is highly demanding, and especially on chaotic shifts, finding time to teach can seem impractical. Nevertheless, teaching can reinforce knowledge and challenge assumptions, which can itself lead to diagnostic efficiency. Perhaps experts employ strategies to balance all of these pressures! This “Great Evidence in Medical education Summary” (GEMeS – pronounced “gems”) was originally posted by the CAEP EWG GEMeS Team on December 12, 2014 and answers the question: “Does quality teaching correlate with clinical productivity?” (In this study, the investigators use a common American ED measure of productivity called “relative value units,” which aims to account for patient complexity in addition to patient volume.) A PDF version of the GEMeS summary is available here.
Does the quality of emergency physician bedside teaching of residents correlate with clinical productivity?
Secondarily, this study sought to explore strategies employed by high-performing faculty to optimize productivity and teaching quality.
FACULTY CLINICAL PRODUCTIVITY AND TEACHING
This is a mixed-methods study. Quantitative analysis of correlations and qualitative analysis of semi-structured interviews using grounded theory were performed.
Vanderbilt University Medical Center – large academic teaching hospital
Per author: Annual census = 60,000 patients, Daily volume = 150-200 patients
Level of Learning
In this mixed-methods study, the authors explored the relationship between emergency physician (EP) productivity and their teaching performance. They conducted a correlation analysis of faculty productivity (as defined by relative value units), patient satisfaction and teaching performance. They determined that higher teaching performance ratings from residents correlated with higher average relative value units. There was no correlation between clinical productivity and patient satisfaction. To further explore strategies for balancing productivity and education, the authors applied a grounded theory approach to analyze transcripts of semi-structured interviews of the highest performing EPs. They found that the use of “clinical pearls” and “teaching moments” were two common techniques used to provide effective on-shift teaching to learners.
In the context of emergency department overcrowding and the creation of national benchmarks for timely care, academic emergency physicians (EPs) are facing added pressures to increase their clinical productivity while preserving both patient satisfaction and their educational responsibilities to trainees. This study provides evidence that emergency physicians do not have to sacrifice teaching to maintain clinical productivity and identifies techniques to balance these two competing responsibilities. The reader should be wary of the differences between the study setting and their own local context when considering the generalizability of the results (e.g., differences in funding structure, patient volume, and resident training level).