How First-Year Doctors Spend Their Time

APRIL 15, 2019
Patrick Campbell
A recent study has found that first-year internal medicine residents are spending just a fraction of their time interacting with patients in a face-to-face setting.

Investigators found that in a 24-hour period, interns spend just 3 hours involved in direct patient care.

Investigators collected time motion data from March 10 through May 31, 2016. Observed shifts were limited to shifts starting on a weekday and included daytime, nighttime, and call shifts. Each observer was assigned to 1 intern at a time and was scheduled so that an intern’s entire shift could be observed while they were working on inpatient general care.

Interns were selected instead of senior residents because they are typically the primary, patient-facing physicians for patients receiving care from resident teams in teaching hospitals. Investigators sought to determine how first-year internal medicine residents allocate their time while working on general medicine inpatient services. 

Data were collected by 23 observers who received 4 hours of in-person training to collect data without interfering with workflow. Investigators observed 10% of shifts simultaneously with 2 observers and 97.7% of the total time expected to be observed was observed. 

Activities performed were assigned to 7 categories adapted from prior time-motion trials. Those 7 categories were then subdivided between required work and not-required work. A total of 80 interns from 6 mid-Atlantic teaching programs were observed for 2173 hours. The mean length of a shift was 10.5 hours.

Investigators observed that 15.9 (66%) hours out of every 24-hour period were spent in indirect patient care. Most of that time (10.3 hours) was spent interacting with the patient’s medical records or recording their work, communicating with core team members (5.9 hours), and communicating with non-team members (3.3 hours).

The next most frequently observed activities were rounds (5 hours) and direct patient care (3 hours). This was followed by education activities (1.8 hours), which consisted primarily of education conferences (1.1 hours). The least observed activity was handing off patient care responsibilities (.8 hours). 

Investigators noted several limitations within their study. Due to the study being limited to internal medicine interns they were unable to determine the actives of interns in other fields. The study observed interns at 6 programs, limiting its generalizability. The interns were only observed during general medical rotations and, while these are a defining experience, interns spend many months in other settings. Lastly, while investigators were able to observe interns there is no standards to identify what distribution of activities is best for their educational experience or the quality of care patients receive.

Investigators concluded that interns are spending substantial time in indirect patient care and are spending little time in face-to-face contact with patients or engaging in educational activities. They believe their findings provide a baseline measurement for future efforts designed to improve the experience of internal medicine trainees and their work day structure.

“This objective look at how interns spend their time during the work day reveals a previously hidden picture of how young physicians are trained, and the reality of medical practice today,” said lead author Krisda Chaiyachati, MD, an assistant professor of medicine at the Perelman School of Medicine of the University of Pennsylvania. “Our study can help residency program leaders take stock of what their interns are doing and consider whether the time and processes are right for developing the physicians we need tomorrow.”

This study, titled “Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations,” was published in JAMA Internal Medicine.

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