In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) common program requirements compress busy inpatient schedules and increase intern supervision. At the same time, interns wrestle with the effects of electronic medical record systems, including documentation needs and availability of an ever-increasing amount of stored patient data.
In light of these changes, we conducted a time motion study to determine how internal medicine interns spend their time in the hospital.
Descriptive, observational study on inpatient ward rotations at two internal medicine residency programs at large academic medical centers in Baltimore, MD during January, 2012.
Twenty-nine interns at the two residency programs.
The primary outcome was percent of time spent in direct patient care (talking with and examining patients). Secondary outcomes included percent of time spent in indirect patient care, education, and miscellaneous activities (eating, sleeping, and walking). Results were analyzed using multilevel regression analysis adjusted for clustering at the observer and intern levels.
Interns were observed for a total of 873 hours. Interns spent 12 % of their time in direct patient care, 64 % in indirect patient care, 15 % in educational activities, and 9 % in miscellaneous activities. Computer use occupied 40 % of interns’ time. There was no significant difference in time spent in these activities between the two sites.
Interns today spend a minority of their time directly caring for patients. Compared with interns in time motion studies prior to 2003, interns in our study spent less time in direct patient care and sleeping, and more time talking with other providers and documenting. Reduced work hours in the setting of increasing complexity of medical inpatients, growing volume of patient data, and increased supervision may limit the amount of time interns spend with patients.
- Common Program Requirements Effective July 1, 2011. Chicago, IL: Accreditation Council for Graduate Medical Education. Available at http://www.acgme.org/acgmeweb/Portals/0/dh_dutyhoursCommonPR07012007.pdf. Accessed January 25, 2013.
- Drolet BC, Spalluto LB, Fischer SA. Residents’ perspectives on ACGME regulation of supervision and duty hours—a national survey. New Engl J Med. 2010;e34:1–4.
- Drolet BC, Christopher DA, Fischer SA. Residents’ response to duty-hour regulations—a follow-up national survey. N Engl J Med. 2012;366:e35. CrossRef
- Mizrahi T. Getting rid of patients: contradictions in the socialization of physicians. New Brunswick, NJ: Rutgers University Press; 1986:14–30.
- Payson HE, Gaenslen EC Jr, Stargardter FL. Time study of an internship on a university medical service. New Engl J Med. 1961;264:439–43. CrossRef
- Gillanders W, Heiman M. Time study comparison of three intern programs. J Med Educ. 1971;46:142–9.
- Lurie N, Rank B, Parenti C, Woolley T, Snoke W. How do house officers spend their nights? A time study of internal medicine house staff on call. New Engl J Med. 1989;320(25):1673–7. CrossRef
- Parenti C, Lurie N. Are things different in the light of day? A time study of internal medicine house staff days. Am J Med. 1993;94:654–8. CrossRef
- Moore SS, Nettleman MD, Beyer S, Chalasani K, Fairbanks RJ, Goyal M, Carter M. How residents spend their nights on call. Acad Med. 2000;75:1021–4. CrossRef
- Dresselhaus TR, Luck J, Wright BC, Spragg RG, Lee ML, Bozzette SA. Analyzing the time and value of housestaff inpatient work. J Gen Intern Med. 1998;13(8):534–40. CrossRef
- Boex JR, Leahy PJ. Understanding residents’ work: moving beyond counting hours to assessing educational value. Acad Med. 2003;78:939–44. CrossRef
- Chung RS, Ahmed N. How surgical residents spend their training time: the effect of a goal-oriented work style on efficiency and work satisfaction. Arch Surg. 2007;142:249–52. CrossRef
- Mitchell J, Hayhurst C, Robinson SM. Can a senior house officer’s time be used more effectively? Emerg Med J. 2004;21:545–7. CrossRef
- Fletcher KE, Visotcky AM, Stagle JM, Tarima S, Weinger MB, Schapira MM. The composition of intern work while on call. J Gen Intern Med. 2012. doi:10.1007/s11606-012-2120-7.
- Jagsi R, Weinstein DF, Shapiro J, Kitch BT, Dorer DJ, Weissman JS. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours an patient safety: a study of resident experiences and perceptions before and after hours reductions. Arch Intern Med. 2008;168(5):493–500. CrossRef
- Oxentenko AS, West CP, Popkave C, Weinberger SE, Kolars JC. Time spent on clinical documentation: a survey of internal medicine residents and program directors. Arch Intern Med. 2010;170(4):377–80. CrossRef
- Mourad M, Vidyarthi A, Hollander H, Ranji S. Shifting indirect patient care duties to after hours in the era of work hours restrictions. Acad Med. 2011;86(5):586–90. CrossRef
- Ampt A, Westbrook J, Creswick N, Mallock N. A comparison of self-reported and observational work sampling techniques for measuring time in nursing tasks. J Health Serv Res Pol. 2007;12(1):18–24. CrossRef
- Morell DC, Evans ME, Morris RW, et al. The “five minute” consultation: effect of time constraint on clinical content and patient satisfaction. Br Med J. 1986;292:870–3. CrossRef
- Wilson A, McDonald P, Hayes L, Cooney J. Health promotion in the general practice consultation: a minute makes a difference. Br Med J. 1992;304:227–30. CrossRef
- Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 2001;14(S1):S34–40. CrossRef
- Tamblyn R, Berkson L, Dauphinee WD, et al. Unnecessary prescribing of NSAIDs and the management of NSAID-related gastropathy in medical practice. Ann Intern Med. 1997;129:429–38. CrossRef
- Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366:1051–56. CrossRef
- Association of Program Directors in Internal Medicine. End of Training EPAs. Available at http://www.im.org/AcademicAffairs/milestones/Pages/EndofTrainingEPAs.aspx. Accessed January 25, 2013.
- McMahon GT, Katz JT, Thondike ME, Levy BD, Loscalzo J. Evaluation of a redesign initiative in an internal-medicine residency. N Engl J Med. 2010;362(14):1304–1311. CrossRef
- Record JD, Rand C, Christmas C, et al. Reducing heart failure readmissions by teaching patient-centered care to internal medicine residents. Arch Intern Med. 2011;171(9):858–9. CrossRef
- In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?
Journal of General Internal Medicine
Volume 28, Issue 8 , pp 1042-1047
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- residency work hours
- graduate medical education
- time motion
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604, Baltimore, MD, 21202, USA
- 2. Division of General Internal Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N13W46, Baltimore, MD, USA
- 3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 653, Baltimore, MD, 21205, USA
- 4. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St., Room 9042, Baltimore, MD, 21202, USA
- 5. Johns Hopkins University, Baltimore, MD, USA
- 6. Division of General Internal Medicine, Johns Hopkins University, 600 North Wolfe Street, Nelson 215, Baltimore, MD, 21287, USA
- 7. University of Maryland Medical Center, 600 North Wolfe Street, Nelson 215, Baltimore, MD, 21287, USA