Absolutely. The guy I spoke with recently at a large US academic ED said
that the requirement initially came from the US government medicare /
Medicaid programmes (govt. health insurance for the >65 and some low-income
families respectively) about 10-15 years ago. However, he claimed that once
the change had been made, the educational and quality-control benefits of
the change were so clear that it was now seen primarily as an educational
issue. I strongly suspect that if for some reason the 'Payors' stopped
requiring this level of supervision, one would see a similar rule being
imposed by ACGME (Accreditation Council for Graduate Medical Education, the
educational body responsible for standards of post-graduate medical
training).

I think the UK public would be willing to fund a similar level of service
here...but only if we in the specialty make the case for it. Of course this
assumes we actually think it's a good idea; after all, if the current
methods of SHO training and supervision represent the 'state of the art' we
don't need to change anything, do we...  :-)


Ghufran

> -----Original Message-----
> From: Accident and Emergency Academic List [mailto:ACAD-AE-
> [log in to unmask]] On Behalf Of Andy Webster
> Sent: 30 August 2004 07:39
> To: [log in to unmask]
> Subject: Re: CRP (+training issues)
>
> >By comparison, from talking to various emergency physicians in the US,
> >there
> >seems to be much closer supervision of trainees there. Apparently
> Emergency
> >medicine residency training there has evolved (for various reasons) into
> a
> >system whereby every patient seen by a trainee has to be 'signed off' by
> a
> >fully trained ER doctor. In the first year or two of training this tends
> to
> >mean the supervising doctor at least 'casts an eye' on every patient and
> >their investigation results etc. In the final year it can just mean that
> >each case is discussed before admission / discharge.
>
> I don't know the system very well, and I don't doubt it would help
> feedback,
> but is there not some financial incentive for attendings to "sign off
> patients" i.e. they get paid for number of cases seen so very beneficial
> to
> have a cursory glance at the patient.
>
> Andy Webster
> Specialist Registrar in Emergency Medicine
> Department of Accident and Emergency Medicine Northern General Hospital
> +44 114 2434343
>