Wednesday, November 17, 2010

ED report card

An emergency department in an academic medical center has an important educational role in training the next generation of emergency medicine doctors. There are at least two measures of how well it is doing. The first is how desirable the program is viewed by potential residents. The second is how well those residents do in their annual examinations.

Here is the trend in our place. Each year we admit about a dozen residents. Note the growth in applicants year to year in the top chart.

And the chart underneath shows their performance on the standardized examination. Nicely above average year after year for all three classes of residents.


Anonymous said...

Paul, Is the growth in applications unique to BIDMC or is it another sign that new doctors are picking specialties like emergency medicine, at the expense of more needed areas of expertise, like primary care? Nancy

Marco Huesch said...

Hi Paul

This is a nerdy comment from an old (and incomplete) ER resident, whose research is all about selection effects.

Let's say the BI can rank applicants by perceived quality. You have an increasingly large pool of applicants to draw from, but a roughly constant number of draws.

So this set-up implies that you ought to expect two things:

(i) above average performance due to selecting the best draws from a large pool, as a static effect, and

(ii) nondecreasing absolute and relative performance, as a dynamic effect, due to the pool increasing over time (can select even better folks as part of your 12)

The interplay between these two selection effects will continue to make your program even more desirable over time, even if your underlying educational capabilities were actually only average!

Of course, similar selection effects can be at play when we think of provider care delivery and quality...


Anonymous said...

I'm told that ED applications are up generally, but that ours are rising at a faster rate.

BachusD said...


Residency selection is a two-way street, BIDMC ranks its candidates, but candidates rank programs, and the Match algorithm finds the best matches between everyones rankings. So the fact that the rankings are gong up for BI indicates that not only are they choosing the best applicants from a large pool, but those applicants must be choosing them. This is a very good indicator of the quality of a program. I am biased, I was in the the third class, 2002, looks like it's gotten a lot tougher to get in since then.