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

ABSTRACT

BACKGROUND

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.

OBJECTIVE

In light of these changes, we conducted a time motion study to determine how internal medicine interns spend their time in the hospital.

DESIGN

Descriptive, observational study on inpatient ward rotations at two internal medicine residency programs at large academic medical centers in Baltimore, MD during January, 2012.

PARTICIPANTS

Twenty-nine interns at the two residency programs.

MAIN MEASURES

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.

KEY RESULTS

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.

CONCLUSIONS

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 WORDS

residency work hours graduate medical education time motion 

REFERENCES

  1. 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. 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
  3. 3.
    Drolet BC, Christopher DA, Fischer SA. Residents’ response to duty-hour regulations—a follow-up national survey. N Engl J Med. 2012;366:e35.PubMedCrossRefGoogle Scholar
  4. 4.
    Mizrahi T. Getting rid of patients: contradictions in the socialization of physicians. New Brunswick, NJ: Rutgers University Press; 1986:14–30.Google Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Gillanders W, Heiman M. Time study comparison of three intern programs. J Med Educ. 1971;46:142–9.PubMedGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Boex JR, Leahy PJ. Understanding residents’ work: moving beyond counting hours to assessing educational value. Acad Med. 2003;78:939–44.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitchell J, Hayhurst C, Robinson SM. Can a senior house officer’s time be used more effectively? Emerg Med J. 2004;21:545–7.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedGoogle Scholar
  15. 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
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 2001;14(S1):S34–40.CrossRefGoogle Scholar
  22. 22.
    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.CrossRefGoogle Scholar
  23. 23.
    Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366:1051–56.PubMedCrossRefGoogle Scholar
  24. 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.
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Lauren Block
    • 1
  • 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

Personalised recommendations