Comparison of the quality of emergency care delivered by resident and attending emergency physicians for patients with acute myocardial infarction

Study objectives: Although some have suggested that physicians in training may provide lower quality of care than more experienced physicians, relatively little is known about differences in the quality of care provided by resident and attending emergency physicians. The objective of this study is to assess differences in rates of use of aspirin, β-blockers, and reperfusion therapy for acute myocardial infarction (AMI) patients with no contraindications to these therapies whose primary emergency department (ED) provider was either a resident or attending emergency physician. Methods: This was a cohort study of 1,458 consecutive, enzyme-confirmed AMI patients presenting to 1 of 3 community EDs in Colorado and California from July 2000 through June 2002. The 3 EDs participated in 3 separate emergency medicine resident training programs. ED and inpatient records were abstracted to obtain information on the use of aspirin, β-blockers, reperfusion therapy, contraindications to these treatments, patient characteristics, clinical factors, and primary ED provider (resident or attending physician). Hierarchical multivariable regression was used to evaluate the relationship between provider type and the receipt of aspirin, β-blockers, and reperfusion therapy in ideal candidates while adjusting for patient characteristics and inhospital clustering. Results: Emergency medicine residents served as the primary provider for 307 patients, whereas emergency medicine attending physicians served as the primary provider for 1,151 patients. Patients cared for by emergency medicine residents were similar to patients cared for by emergency medicine attending physicians for all demographic, medical history, and clinical characteristics. Treatment rates were similar for patients cared for by residents and attending physicians for aspirin (resident 81.2% versus attending physician 77.2%, P=.15) and β-blockers (54.6% versus 53.4%, P=.80). Treatment with reperfusion therapy for eligible patients cared for by residents was actually higher than for patients cared for by attending physicians (resident 77.8% versus attending physician 62.6%, P=.02). Results did not significantly change in regression analyses that controlled for patient demographic, medical history, and clinical characteristics. Conclusion: ED use of aspirin and β-blocker therapy for eligible AMI patients did not vary significantly for patients cared for by resident versus attending emergency physicians. ED use of reperfusion therapy for eligible AMI patients was higher in patients primarily cared for by residents than patients primarily cared for by attending emergency physicians. Perceptions that physicians-in-training may provide lower quality of care because of their inexperience were not supported in this study.