Original ContributionsMedical student effect on emergency department length of stay*
Introduction
A recent law has created emergency departments in France.1, 2 Clinical training is now provided in the ED for residents (in all hospitals) and medical students (in university hospitals). Because emergency medicine is not yet a recognized specialty in France, university teaching does not include emergency medicine, and clinical training in the ED is very important. Although it seems intuitively evident that a senior physician providing patient care alone would be more efficient than a senior physician providing care, supervision, and education, we sought to quantify this effect. Profiting from a special situation, we determined whether patient length of stay (LOS) was affected by the presence of medical students in our ED.
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Materials and methods
The setting was a university hospital (675 beds) with an ED census of 38,000 adults. The staff was composed of 1 senior attending physician, 3 residents, and 3 medical students 24 hours a day. Every morning, at the beginning of duty, each student was assigned to a resident (creation of binomials). Each binomial was responsible for specific patients. The senior physician was responsible for supervision. In special situations (life-threatening conditions), the senior physician could assume total
Results
Eight hundred thirty-one patients were studied over the 2 periods (393 for the strike period and 438 for the control period). For statistical purposes (χ2 test), CCMU classes IV and V had to be grouped together. Age and LOS were analyzed by using a nonparametric test (Mann-Whitney U test) because the conditions of applicability for ANOVA were not met (distribution not normal and variance nonhomogeneous). No significant difference was highlighted for the general characteristics, gravity,
Discussion
To our knowledge, this is the first report demonstrating the effect of medical students on ED LOS. The effects of the medical students could be isolated because of the student strike. Comparison with a control period provided strong evidence that other variables, such as age, sex, disposition, gravity, diagnosis, test use, and bed availability, were not responsible for the difference in LOS. Diagnoses were categorized into 7 general groups, and further stratifying diagnoses would have resulted
References (4)
Décret n° 95-647 du 9 mai 1995 relatif à l'accueil et au traitement des urgences dans les établissements de santé et modifiant le code de la santé publique
Journal Officiel.
(1995;May)Décret n° 95-648 du 9 mai 1995 relatif aux conditions techniques de fonctionnement auxquelles doivent satisfaire les établissements de santé pour être autorisés à mettre en œuvre l'activité de soins Accueil et traitement des urgences et modifiant le code de la santé publique
Journal Officiel
(1995;May)
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Address for reprints: Patrick Gerbeaux, MD, Service des Urgences, Hôpital de la Conception, 147 Bd Baille, 13385 Marseille, France;,33 04 91 38 36 52, fax,33 04 91 38 36 71;, E-mail [email protected].