Teaching and Clinical Efficiency: Competing Demands

Introduction: Teaching ability and efficiency of clinical operations are important aspects of physicianperformance. In order to promote excellence in education and clinical efficiency, it would be importantto determine physician qualities that contribute to both. We sought to evaluate the relationship betweenteaching performance and patient throughput times.Methods: The setting is an urban, academic emergency department with an annual census of 65,000patient visits. Previous analysis of an 18-question emergency medicine faculty survey at this institutionidentified 5 prevailing domains of faculty instructional performance. The 5 statistically significantdomains identified were: Competency and Professionalism, Commitment to Knowledge andInstruction, Inclusion and Interaction, Patient Focus, and Openness and Enthusiasm. We fit amultivariate, random effects model using each of the 5 instructional domains for emergency medicinefaculty as independent predictors and throughput time (in minutes) as the continuous outcome. Facultythat were absent for any portion of the research period were excluded as were patient encounterswithout direct resident involvement.Results: Two of the 5 instructional domains were found to significantly correlate with a change inpatient treatment times within both datasets. The greater a physician’s Commitment to Knowledge andInstruction, the longer their throughput time, with each interval increase on the domain scale associatedwith a 7.38-minute increase in throughput time (90% confidence interval [CI]: 1.89 to 12.88 minutes).Conversely, increased Openness and Enthusiasm was associated with a 4.45-minute decrease inthroughput (90% CI: 8.83 to 0.07 minutes).Conclusion: Some aspects of teaching aptitude are associated with increased throughput times(Openness and Enthusiasm), while others are associated with decreased throughput times(Commitment to Knowledge and Instruction). Our findings suggest that a tradeoff may exist betweenoperational and instructional performance.