In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?
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.
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- 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