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Reduced productivity among junior trainees in the emergency department and the impact on senior clinicians
  1. Peter A R Armstrong,
  2. Alison L White,
  3. Shobhan Thakore
  1. Emergency Department Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to Dr P A R Armstrong, Emergency Department, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; peter.armstrong{at}


Emergency medicine has recently undergone significant changes, with training, staffing and service delivery attracting particular attention. Senior doctors are under increased pressure to ensure the prompt delivery of service and to provide a smooth patient journey. It has been suggested that junior trainees see fewer patients than their predecessors, resulting in the burden of clinical work being transferred to senior clinicians, representing a shift away from the traditional model of service delivery. This study charts the work rate trends among junior doctors and the proportion of work performed by senior doctors over a 3-year period.

Results The number of patients seen by junior trainees fell by 4% and was associated with a statistically significant 16.6% reduction in the mean number of patients seen per hour. The number of patients seen purely by senior clinicians increased to over 35%, in addition to reviewing those seen by junior trainees. This highlights reduced clinical exposure and productivity among juniors, but also shows the significant knock-on effect on the workload of senior clinicians.

Conclusions There will need to be an increase in the number of trained clinicians within emergency medicine to continue to deliver effective training and supervision and ensure a safe, good quality service to patients.

  • Trainees
  • emergency
  • productivity
  • workload
  • workforce
  • emergency care systems, efficiency
  • management, emergency department management

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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