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Negligible Effect of Medical Students on ED Length of Stay

PHILADELPHIA – How much do medical students slow down the process in busy emergency departments?

Not much, according to a research letter published in a special medical education issue of JAMA.

Background information in the report, based on research from the Perelman School of Medicine at the University of Pennsylvania, notes that medical students typically perform an initial evaluation of stable patients in EDs prior to supervising residents or attending physicians.

That adds fewer than five minutes to the average length of stay for ED patients, according to the study.

No other significant differences were identified among visit covariates, including ICD-9 code prevalence, between clerkship and control weeks. Weekly resident turnover rate, while significantly lower during the clerkship weeks compared with the control weeks, was not correlated with LOS.

"There has been concern that medical students may appreciably increase patient length of stay in the emergency department," said senior author Kevin R. Scott, MD. "But our findings show only a minimal increase, one that is probably imperceptible to most patients and likely clinically insignificant. What this demonstrates is that medical students are afforded excellent educational opportunities in the emergency department, and can balance this with the desire of both patients and physicians to reduce length of stay."

For the study, the research team compared patient length of stay during a required emergency room rotation for medical students compared to a time period when medical students were not in the ED. Evaluating more than 1.3 million patient cases over a 15-year period at three hospitals, the study team found the total average length of stay was 264.7 minutes, while length of stay was 4.6 minutes longer when students were involved in assessing patients.

"As students, we gradually transition from observing to aiding medical care, but sometimes worry that the additional time we spend with patients may slow care," explained lead author Kimon L.H. Ioannides, a fourth year medical school student at Penn. "This study provides some reassurance that our teachers are able to minimize delays in care for our patients during this transition.”