A study in the December 10 issue of JAMA, a theme issue on medical education, in a sample of U.S. emergency departments, compared to attending physicians alone, found that supervised visits (involving both resident and attending physicians) were associated with a greater likelihood of hospital admission and use of advanced imaging and with longer emergency department stays.
A common assumption is that care at academic medical centers costs more than care at nonteaching hospitals in part because of a higher frequency of testing and other resource use in teaching settings. Cost-effective care is among the "milestones" now used to evaluate emergency medicine residents and accredit emergency medicine residency programs. Although there is evidence that resident supervision may improve some patient outcomes, few studies of supervised learning have explicitly evaluated resource use as an outcome, according to background information in the article.
Stephen R. Pitts, M.D., M.P.H., of the Emory University School of Medicine, Atlanta, and colleagues compared resources used in supervised vs attending-only visits with data from the National Hospital Ambulatory Medical Care Survey (2010), a sample of U.S. emergency departments (EDs) and ED visits.
"In our study of a nationally representative sample of ED visits, we hypothesized that supervised visits would consume more resources than nonsupervised visits, reasoning that supervised learning favors a more deliberate, reflective decision-making style than nonteaching clinical visits. We confirmed consistently higher use of several ED resources among supervised visits even after adjustment for several other possible determinants of resource use that were available in the survey," the authors write.
(doi:10.1001/jama.2014.16172; Available pre-embargo to the media at http://media.jamanetwork.com)