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What factors go into attending physician’s decisions about the roles and responsibilities of emergency medicine residents in a free-standing pediatric emergency department?
Jennifer Mitzman, MD, Maegan Reynolds, MD, David P. Way, MEd
The Ohio State University Wexner Medical Center
Background (Click)
Material & Methods (Click)
Conclusion (Click)
Emergency medicine (EM) residents require pediatric experiences. Some programs arrange experiences in separate, independent pediatric emergency departments (PEDs). EM residents who rotate in a PED see more patients and perform more procedures than family medicine or pediatric residents.1-2 However, pediatric residents see more critically ill patients than EM residents in a PED.3 Our question was: How do supervising faculty in the pediatric ED decide which residents get to do what?
EM Residents (n=52) completed all rotations in a free-standing children’s hospital PED staffed by 60 pediatric emergency physicians.
All EM residents and faculty were polled regarding their opinions about how faculty make decisions that influence resident autonomy and resident participation in patient care.
Faculty and residents disagree about how
faculty make decisions.
Most faculty use familiarity to decide about
resident autonomy (which has implications for scheduling).
Residents believe faculty decide based on numerous criteria.
References
Objectives (Click)
Results (Click)
IMAGE
Chen EH, et al. Emergency Medicine Resident Rotation in Pediatric Emergency Medicine: What Kind of Experience
Are We Providing? Acad Emerg Med. 2004;11:
Dowd, MD, et al. Resident efficiency in a pediatric emergency department. Acad Emerg Med 2005;12:
3. Chen EH, et al. Resident Exposure to Critical Patients in a Pediatric Emergency Department. Pediatr Emerge Care. 2007;23:
Residents believed faculty decisions are based on:
Patient acuity / procedural difficult
Faculty-Resident familiarity (relationship)
Resident’s Level of Training
Resident’s Confidence.
Faculty treat all residents the same (EM=Peds=FM). Most said residents are allowed to chose their patients. Most faculty (77%) make decisions about resident autonomy based on familiarity of the resident. Some make decisions based on level of training.
1. What factors go into faculty decisions to allow EM residents to: see patients, perform procedures, and work autonomously in the pediatric ED.
2. What is the common understanding of faculty and residents when it comes to these decision factors.
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2. Background and Objectives
Emergency medicine (EM) residents require pediatric experiences. Some programs arrange experiences in separate, independent pediatric emergency departments (PEDs). EM residents who rotate in a PED see more patients and perform more procedures than family medicine or pediatric residents.1-2 However, pediatric residents see more critically ill patients than EM residents in a PED.3 Our question was: How do supervising faculty in the pediatric ED decide which residents get to do what?
What criteria do PED faculty use to allow EM residents to:
see patients,
perform procedures, and
work autonomously
2. What is the common understanding of faculty and residents when it comes to these decision criteria.

3. Materials and Methods Custom Survey EM Residents (n= 25/52 or 48.1%)
Patient acuity
Informal assessment of resident’s ability
Resident level of training
Presence of an EM Fellow
Resident’s program affiliation
How well I know the resident
Resident’s confidence
Resident’s personality
Other criteria…please specify
EM Residents
(n= 25/52 or 48.1%)
PED Faculty
(n= 35/60 or 58.3%)
Select criteria you think faculty use to decide to allow a resident to:
1. See a patient
2. Perform procedures
3. Have autonomy
Select the criteria that go into your decision to allow residents to:
1. See a patient
2. Perform procedures
3. Have autonomy

4. Results 1

5. Results 2

6. Results 3

7. Results 4

8. Conclusion
Faculty and residents disagree about how
faculty make decisions.
Most faculty use familiarity to decide about
resident autonomy (which has implications for scheduling).
Residents believe faculty decide based on numerous criteria.