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Abstract
Aims and Objectives Identifying means to optimise trainee retention and recruitment is an Emergency Medicine (EM) research priority. Worthwhile training opportunities are central to this. This study aimed to understand how increasingly crowded Emergency Departments (EDs) are impacting EM training in the United Kingdom.
Method and Design We conducted a three-armed mixed methods study.
Systematic Review: Performed in accordance with PRISMA guidelines. Data extraction and synthesis were done via an integrated design mixed research synthesis model.
Quantitative: General Medical Council (GMC) training survey data from 2016 to 2019 and 2022 was collated and compared to the percentage of ED attendances under four hours
Qualitative: trainees were recruited to participate in video–recorded, online focus groups exploring their training experiences. Transcribed data were analysed using reflexive thematic analysis.
Results and Conclusion Systematic Review: 22 papers were identified. None were UK based. Four semantic themes were identified: ‘More patients does not mean more procedures’, ‘Crowding leads to less feedback’, ‘Good training is more than the training environment’, ‘More efficient, means less education’.
Quantitative: There was a significant correlation between the percentage of waits under four hours and overall satisfaction (r=0.23, P<0.001), workload (r=0.24, P<0.001) and adequate experience scores (r=0.26, P<0.001).
Qualitative: We conducted 13 focus groups involving 67 EM trainees in the UK between October 2022 and March 2023. Three themes were identified:
‘Crowding is a feeling, you know it’s crowded, right?’– what does a crowded ED mean to trainees.
‘Crowding is defining our speciality’– crowding is changing what we do and leading to the speciality becoming less attractive to trainees.
‘Culture eats strategy for breakfast’– a positive culture of prioritising training is required to nullify the negative effects of crowding.
In conclusion, this study has found that crowding detrimentally effects EM trainees. A cultural change in prioritising training over targets may prevent crowding defining our speciality.
