ArticleThe western journal of emergency medicine2026
Resident Exposure to Acutely Ill Patients Over the Course of Residency.
Article in The western journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionEmergency medicine literature has long debated the "black cloud" and "white cloud" phenomena, which suggest individual variability in exposure to acutely ill patients. If true, this variation may have significant implications for resident training. This study investigates whether emergency medicine (EM) residents consistently encounter differing volumes of high-acuity clinical encounters throughout their training.
methodsThis retrospective cohort study analyzed 11 years of electronic health record (HER) data from a Midwestern academic emergency department to quantify the number of acutely ill adult patients seen by EM residents across three years of training, using a consensus-based set of clinical criteria. Our primary outcome was the concordance of the ranking of each resident within their cohort by number of acutely ill patients seen during postgraduate year one (PGY 1) compared to PGY 3. Statistical analyses to assess this outcome included weighted kappa and linear regression.
resultsA total of 93 EM residents met the criteria for inclusion and saw a total of 359,736 patients during their residency (average 3,493 per resident). Residents saw an average of 167.5 (19.8) acutely ill patients during their residency training. This volume increased sharply by year, with PGY-1 residents seeing an average of 23.8 (7.3) acutely ill patients, and PGY-3 residents seeing an average of 100.3 (19.4). Both weighted kappa (κ = -.274) and linear regression analysis (β = -0.84; 95% CI, -1.4 to -0.31; P = .002) indicated that a resident who saw more acutely ill patients than average in PGY 1 was more likely to see fewer acutely ill patients than average during PGY 3. Results were unaffected by the COVID-19 years or subsequent critical care fellowship pursuit.
conclusion"Cloud type" (as measured by EHR-documented care for acutely ill patients) does not appear to be a stable trait over time. Our findings are consistent with previous studies that found no association between residents' "cloudiness" and objective measures of workload. Using EHR data to track resident clinical exposures helps educators identify training gaps and target remediation through in situ or simulated experiences.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.