{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T17:56:05Z","timestamp":1783792565240,"version":"3.55.0"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"5","license":[{"start":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T00:00:00Z","timestamp":1721260800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>Introduction: Effective medical education must balance clinical service demands for institutions and learning needs of trainees. The question of whether these are competing demands or can serve complementary roles has profound impacts on graduate medical education, ranging from funding decisions to the willingness of community-based hospitals and physicians to include learners at their clinical sites. Our objective in this article was to systematically review the evidence on the impact of medical trainees on productivity and ef\ufb01ciency in the emergency department (ED). Methods: We queried PubMed, Embase, Scopus, and Web of Science from earliest available dates to March 2023. We identi\ufb01ed all studies evaluating the impact of medical students and\/or residents in the ED on commonly used productivity and ef\ufb01ciency metrics. Only studies in EDs in the United States were included. No additional \ufb01lters were used. We assessed the risk of bias of included studies using the Risk of Bias in Non-randomized Studies \u2013 of Interventions (ROBINS-I) tool. Certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study \ufb01ndings were combined in a narrative synthesis and reported according to PRISMA guidelines. Results: The literature search yielded 3,390 unique articles for abstract screening. Eighty-one abstracts were identi\ufb01ed as relevant to our PICO question (population, intervention, control, and outcomes), 76 of which had retrievable full-text articles and the themes of which were discussed in a narrative synthesis. We selected 13 of the full-text articles for \ufb01nal inclusion in a systematic review. Studies were roughly split between observational (6) and quasi-experimental (7) designs. The majority of studies (11) were single-site studies. Only two studies could be graded as low risk of bias per the ROBINS-I tool. Conclusion: Low-GRADE evidence suggests that students and residents decrease ED ef\ufb01ciency by a statistically small effect size of debatable clinical importance. Residents provide a moderate boost to ED productivity. Students do not produce a statistically or clinically signi\ufb01cant impact on ED productivity. Residents increase emergency department relative value units revenue by $26.30 an hour, while students have no impact. Both types of learners decrease ef\ufb01ciency.<\/p>","DOI":"10.5811\/westjem.18574","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T19:47:57Z","timestamp":1721332077000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of Medical Trainees on Efficiency and Productivity in the Emergency Department: Systematic Review and Narrative Synthesis"],"prefix":"10.5811","volume":"25","author":[{"given":"Jake","family":"Valentine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Poulson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Tamayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Valentine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Levesque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Jenks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2024,7,18]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"link":[{"URL":"https:\/\/escholarship.org\/content\/qt6j4973xw\/qt6j4973xw.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T19:38:27Z","timestamp":1726688307000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/6j4973xw"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,18]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,9,18]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.18574","relation":{},"ISSN":["1936-9018"],"issn-type":[{"value":"1936-9018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,18]]}}}