Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1042–1047 | Cite as

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

  • Lauren BlockEmail author
  • Robert Habicht
  • Albert W. Wu
  • Sanjay V. Desai
  • Kevin Wang
  • Kathryn Novello Silva
  • Timothy Niessen
  • Nora Oliver
  • Leonard Feldman
Original Research



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.


residency work hours graduate medical education time motion 




We would like to acknowledge the Osler Center for Clinical Excellence at Johns Hopkins, as well as the Johns Hopkins Hospitalist Scholars Fund, which funded stipends for our observers as well as transportation and logistical costs of the study.

Prior Presentations

This work was presented as a poster at the Johns Hopkins Institute for Excellence in Education Conference on March 23, 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Lauren Block
    • 1
    Email author
  • Robert Habicht
    • 2
  • Albert W. Wu
    • 1
    • 3
  • Sanjay V. Desai
    • 4
  • Kevin Wang
    • 5
  • Kathryn Novello Silva
    • 2
  • Timothy Niessen
    • 1
    • 6
  • Nora Oliver
    • 7
  • Leonard Feldman
    • 1
    • 6
  1. 1.Division of General Internal MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Division of General Internal MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Division of Pulmonary and Critical Care Medicine, Johns Hopkins UniversityBaltimoreUSA
  5. 5.Johns Hopkins UniversityBaltimoreUSA
  6. 6.Division of General Internal MedicineJohns Hopkins UniversityBaltimoreUSA
  7. 7.University of Maryland Medical CenterBaltimoreUSA

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