Paper 8

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Impact of Trainees on Patient Appointment Time in a Pediatric Ophthalmology Clinic

 Michael F. Chiang; Isaac H. Goldstein; Sarah Read-Brown; Michelle R. Hribar
Oregon Health & Science University
Portland, OR

Introduction:  Academic pediatric ophthalmologists face special challenges in clinical efficiency as they balance providing medical care with educating medical trainees. However, few studies have explored the relationship between medical education and clinical efficiency. To address this gap, this study examines the effect of presence of medical trainees on pediatric ophthalmology patient appointment times.

Methods:  Data about 7,239 pediatric ophthalmology appointments with 4 pediatric ophthalmologists and 1 pediatric optometrist at Oregon Health and Science University (OHSU) Casey Eye Institute were analyzed. Presence of trainees as well as patient appointment time was determined by electronic health record visit data and audit logs. Differences in appointment length were tested by Welch’s t-test and linear mixed models.

Results:  The average lengths of appointments with residents and fellows were significantly greater than appointments in clinic sessions without trainees (107.0±40.7 vs. 86.4±37.3 minutes, p<.001 for residents, and 104.7±38.5 vs. 86.4±37.3 minutes, p<.001 for fellows). Appointments with no trainee present in clinic sessions with trainees were also on average significantly longer than appointments in clinic sessions without trainees (91.9±36.1 vs. 86.4±37.3 minutes, p<.001).

Discussion:  Key findings from this study are that (1) Trainees are associated with a significant lengthening of appointment time. (2) Trainees lengthen all appointments in a clinic session, even for appointments for which they were not present.

Conclusion:  Presence of trainees was associated with longer appointment times, even for patients not seen by a trainee. This has important implications for efficiency of clinical care in academic centers and for pediatric ophthalmology education, and raises questions about provider reimbursement models.

1. Oberlander J, Laugesen MJ. Leap of Faith – Medicare’s New Physician Payment System. N Engl J Med 2015;373(13):1185-7.
2. Irby DM, LuAnn Wilkerson. Teaching when time is limited. BMJ 2008;336:384-7.
3. Hribar MR, Read-Brown S, Goldstein IH, Reznick LG, Lombardi L, Parikh M, Chamberlain W, Chiang MF. Secondary use of electronic health record data for clinical workflow analysis. J Am Med Inform Assoc 2017. In press.

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