196 Chapter 8 Supplementary material 2. Calculations of the reduction of working hours for medical specialists set against the hours of students and residents A medical student spent 9.1 minutes (± 1.2 SD, range 7.5 to 10.7) on the independent assessment of a study participant. A resident spent on average 11.2 minutes on the assessment of a study participant. The discussion time per case during the consensus meeting of the students and the resident was on average 4.6 minutes. Individual assessment of paper vignettes by a member of the expert panel took approximately 8 minutes per case. The discussion time per case during the consensus meeting of the medical specialists was 3.5 minutes. Extrapolation to entire OPTIMACT cohort of 2,418 patients Working hours medical students: 2,418 cases times 9.1 minute per case times two medical students equals 44,007.6 minutes of individual assessment. Based on this study, 45% of the study population is discussed during a consensus meeting with a resident: 45% of 2,418 cases equals 1,088 cases times 4.6 minutes discussion times two medical students equals 10,010.5 minutes. The total working hours of medical students equals 900 hours and 20 minutes. Working hours residents: based on this study, 45% of the study population is assessed by residents. 45% of 2,418 cases equals 1,088 cases times 11.2 minutes individual assessment plus 4.6 minutes discussion time equals 17,190.4 minutes. The total working hours of residents equals 286 hours and 30 minutes. Based on this study, 24% of the study population needs to be classified by medical experts. Working hours medical specialists when all 2,418 patients were to be assessed by the expert panel (ergo: without the structured approach as presented in this study): all 2,418 cases would be assessed by the internist and pulmonologist: 2,418 cases times 8 minutes individual assessment times 2 experts (internist and pulmonologist) equals 38,688 minutes. Based on this study, 30% of these cases need to be assessed by the cardiologist as well (18 of the 60 cases in our validation study): 30% of 2,418 cases equals 725 cases times 8 minutes individual assessment times 1 expert (cardiologist) equals 5800 minutes. Based on this study, 43% of the cases is discussed during a consensus meeting of the expert panel (consisting of the internist, pulmonologist and chest radiologist): 43% of 2,418 cases equals 1,048 cases times 3.5 minutes discussion times 3 experts equals 11,004 minutes. The total working hours of medical specialists would equal 924 hours and 52 minutes. Working hours medical specialists when only 24% of the patients need to be assessed by the expert panel (ergo: with the structured approach as presented in this study). 24% of the abovementioned 924 hours and 52 minutes equals 221 hours and 58 minutes. The benefit would equal 702 hours and 54 minutes (924 hours and 52 minutes minus 221 hours and 58 minutes). Conclusion If the presented method is applied to the entire OPTIMACT study group of 2,418 patients, it is estimated to save approximately 703 hours of work by medical specialists. This has to be set against the (less expensive) hours of students and residents, which would approximate 900 hours and 286 hours, respectively.
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