In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?
- 2.9k Downloads
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.
KEY WORDSresidency 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.
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.
- 1.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.
- 2.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.Google Scholar
- 4.Mizrahi T. Getting rid of patients: contradictions in the socialization of physicians. New Brunswick, NJ: Rutgers University Press; 1986:14–30.Google Scholar
- 15.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.PubMedCrossRefGoogle Scholar
- 24.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.