Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine

Abstract

BACKGROUND Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. METHODS We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores. RESULTS There were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees’ perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by program directors and faculty of whether trainees’ workload exceeded their capacity (primary outcome for faculty satisfaction with education; response rate, 90%). Another survey of interns (response rate, 49%) revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality (odds ratio, 1.67; 95% confidence interval [CI], 1.02 to 2.73) and overall well-being (odds ratio, 2.47; 95% CI, 1.67 to 3.65). In contrast, directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching (response rate, 98%; odds ratio, 0.13; 95% CI, 0.03 to 0.49). Average scores (percent correct answers) on in-training examinations were 68.9% in flexible programs and 69.4% in standard programs; the difference did not meet the noninferiority margin of 2 percentage points (difference, −0.43; 95% CI, −2.38 to 1.52; P = 0.06 for noninferiority). CONCLUSIONS There was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies. Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs, but program directors were more satisfied. (Funded by the National Heart, Lung, and Blood Institute and the ACGME; iCOMPARE ClinicalTrials.gov number, NCT02274818.)

Portable Ultrasound Device Usage and Learning Outcomes Among Internal Medicine Trainees: A Parallel-Group Randomized Trial

“…First, time-motion studies have demonstrated that internal medicine interns spend less than 15% of their time toward direct patient care. 38 It is possible that the demands of being an intern impeded their ability to perform more POCUS examinations on their patients, regardless of HUD access. Alternatively, the interns randomized to no personal access may have used the community device more frequently as a result of the lecture series.…”

Contemporary Issues in Women's Health

“…By contrast, the directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching. There was no significant difference in the average scores (percent of correct answers) on in‐training examinations—68.9% in flexible programs and 69.4% in standard programs …”

“…The iCOMPARE randomized trial was carried out in 63 internal medicine residency programs in the USA . Programs were randomized to use either the standard duty‐hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or more flexible policies that did not include specific limits on the length of shifts or any mandatory time off between shifts.…”

“…Programs were randomized to use either the standard duty‐hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or more flexible policies that did not include specific limits on the length of shifts or any mandatory time off between shifts. Observations of intern activities, trainee surveys (both interns and residents) and faculty, and intern examination scores were used to measure educational experience …”

Characterizing Inpatient Medicine Resident Electronic Health Record Usage Patterns Using Event Log Data

“…Instead, we may progressively find their attention dominated by electronic health records (EHR) that mediate their work and proxy for their patients. 1 Observational studies confirm an increasing shift from direct patient care to computer use in the wake of duty hour restrictions, 2,3,4 informing ongoing reforms into the structure of medical training. 5 Physicians report increasing time spent on paperwork and the computer 6 , alongside less time available for clinical interactions with patients.…”