Medical students in emergency departments and patient length of stay

An analysis of more than 1.3 million emergency department visits found an increase in patient length of stay of approximately 5 minutes associated with the presence of medical students in the emergency department, which was statistically significant but likely too small to be of clinical relevance, according to a study in the December 8 issue of JAMA, a theme issue on medical education.

Quantitative assessments of how trainees affect patient care have been limited, especially in the emergency department (ED). As EDs host more core clerkship courses, less experienced students have become involved in bedside care. Kevin R. Scott, M.D., of the University of Pennsylvania, Philadelphia, and colleagues examined patient visits from 2000 through 2014, calculating length of stay (LOS) from arrival until ED discharge or admission, and comparing clerkship student presence with student absence from the ED. The study was conducted at 3 urban, academic EDs associated with the University of Pennsylvania Health System, Philadelphia.

More than 1.3 million ED visits were analyzed. Average LOS was 265 minutes overall; adjusted LOS was 4.6 minutes longer when clerkship students were present in the ED. This was significant across all 3 hospitals. Subanalysis of each year at each site showed that LOS was either longer when students were present or not significantly different from the control weeks.

"Future studies should assess different student experiences and other patient­centered or financial outcomes," the authors write.