The On-Call Experience of Interns in Internal Medicine

Nerenz, David R.; Rosman, Howard; Newcomb, Carol; Bolton, Mary Beth; Heudebert, Gustavo R.; Simmer, Thomas; Goldstein, Sidney

doi:10.1001/archinte.1990.00390220050010

Cited by 38 publications

(11 citation statements)

References 9 publications

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“…Our study shows that most ED intern time (86.6%) is spent on patient‐related clinical tasks. This is comparable with an Australia‐wide ED‐based finding (84.1%), 2 but exceeds those of United States‐based studies of ED, 9 surgical, 10 and internal medicine 11 intern rotations (58%, 40%, 30%–62%).…”

Section: Discussionsupporting

confidence: 69%

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An observational study of emergency department intern activities

Zhu

Weiland

Taylor

et al. 2008

Medical Journal of Australia

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Objectives: To describe how intern time is spent, and the frequency of activities performed by interns during emergency department (ED) rotations. Design and setting: Prospective observational study of 42 ED interns from three Melbourne city teaching hospitals during 5 months in 2006. Direct observations were made by a single researcher for 390.8 hours, sampling all days of the week and all hours of the day. Main outcome measures: Proportion of time spent on tasks and number of procedures performed or observed by interns. Results: Direct patient‐related tasks accounted for 86.6% of total intern time, including 43.9% spent on liaising and documentation, 17.5% obtaining patient histories, 9.3% on physical examinations, 5.6% on procedures, 4.8% ordering or interpreting investigations, 3.0% on handover and 4.9% on other clinical activities. Intern time spent on non‐clinical activities included 4.2% on breaks, 3.7% on downtime, 1.7% on education, and 1.3% on teaching others. Adjusted for an 8‐week term, the ED intern would take 253 patient histories, consult more senior ED staff on 683 occasions, perform 237 intravenous cannulations/phlebotomies, 39 arterial punctures, 12 wound repairs and apply 16 plasters. They would perform chest compressions under supervision on seven occasions, observe defibrillation twice and intubation once, but may not see a thoracostomy. Conclusions: The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience.

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Section: Discussionsupporting

confidence: 69%

“…While the observation method used may have elicited practice changes secondary to the presence of an observer (the Hawthorne effect), covert observation of interns is unlikely to be ethical or possible. Indeed, the importance of direct observation has been previously emphasised 11 …”

Section: Discussionmentioning

confidence: 99%

An observational study of emergency department intern activities

Zhu

Weiland

Taylor

et al. 2008

Medical Journal of Australia

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“…Others have evaluated how residents bal-ance these responsibilities in a specific specialty. [1][2][3][4][5][6][7][8][9] However, relatively little is known about the differences in resident time use across specialties. In a companion article, we reported the differences in medical education time commitment between rotations of first-postgraduate-year (PGY1) residents on surgery, internal medicine (IM), and emergency medicine (EM) at one university.…”

mentioning

confidence: 99%

First‐postgraduate‐year Resident Clinical Time Use on Three Specialty Rotations

Magnusson

Hedges

Harper

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: To compare in-hospital time uses by first-postgraduate-year (PGY1) residents during rotations in emergency medicine (EM), internal medicine (IM), and surgery (S). This article reports the clinical components of residency time use. Methods: A cross-sectional, observational study of the clinical activities of EM PGY1 residents was performed while the residents were on duty during the three specialty rotations. The activities were recorded by an observer using a log with predetermined categories for clinical activities. A time-blocked, convenience sample of resident shifts was observed for each service rotation. The sample was proportional to the total number of hours for which a PGY1 resident was expected to be in the hospital during a rotation on that service. No attempt was made to sample the same resident at all time periods or on all rotations. Proportions were compared by 2 ; ␣ = 0.0001. Results: Twelve PGY1 residents were observed for a total of 166 hours on S, 156 hours on IM, and 120 hours on EM. These hourly amounts were representative of a typical two-week span of service on each rotation for the residents. On average, the residents spent 57% of their time on clinical or service-oriented activities. During EM and IM rotations, the residents spent most of their time performing clinical information gathering and engaging in case management and data synthesis (52% of total clinical effort). Within this category, residents on EM were more involved with case discussion and review of ancillary test results than on IM (34% vs 20% of time in this category). Conversely, proportionately less time in this category was devoted to documentation on the EM vs IM rotation (56% vs 80%; p < 0.0001). The greatest opportunity to perform procedures was on the S rotation (31% of total clinical time vs 6% for other specialties; p < 0.0001). Conclusion: Awareness of the clinical activities performed on PGY1 rotations can help residency directors anticipate educational needs to balance their residents' experience. Since 29% and 42% of total clinical time on PGY1 EM and IM rotations, respectively, is focused on documentation, efforts to enhance charting skills and efficiency are warranted. Also, efforts to enhance PGY1 procedural experience outside of the S rotation appear warranted.

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“…Previous studies of housestaff time allocation have used one of three methods: time diaries, 8 time-andmotion analysis, [9][10][11][12][13][14][15][16] or work sampling. 17,18 Retrospective time diaries may inaccurately describe time allocation owing to biased recall.…”

mentioning

confidence: 99%

Analyzing the time and value of housestaff inpatient work

et al. 1998

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OBJECTIVE:To determine time allocation and the perceived value to education and patient care of the weekday activities of internal medicine housestaff on inpatient rotations and to compare the work activities of interns and residents.DESIGN: An observational study. We classified activities along five dimensions (association, location, activity, time, and value), developed a computer-assisted self-interview survey, and demonstrated its face and content validity, internal consistency, and interrater reliability. Subjects were assigned survey computers for 5 consecutive weekdays over a 24-week period, into which they entered data when prompted several times a day. SETTING:The medical service of a university-affiliated Veterans Administration Medical Center. PARTICIPANTS:Sixty housestaff (36 interns, 24 residents) rotating on the inpatient wards. MEASUREMENTS AND MAIN RESULTS:We analyzed activities according to content (direct patient care, indirect patient care, education), association, and location. Likert-scale ratings of perceived value to education and patient care were also obtained. Housestaff provided complete responses to 3,812 (95%) of 3,992 prompts by a median of 11 seconds; 93% of responses were logically consistent across the measured dimensions. Housestaff spent more time in indirect patient care (56%) than in direct patient care (14%) or educational activities (45%). Formal educational activities had the highest educational value (66 on 0-100 scale), and direct care had the highest value to patient care (81). Over 30% of time was spent in administrative activities, which had low educational value (40). Compared with residents, interns allocated significantly less time to educational activities (38% vs 57%) and more time to lower-value activities such as documentation (19% vs 12%). CONCLUSIONS:Improved data collection methods demonstrate that housestaff in our program, particularly interns, spend much of their workday in activities that are low in educational and patient care value. Selective elimination or delegation of such activities would preserve higher-value experiences during reductions in overall inpatient training time. Planners can use automated random sampling to guide the rational redesign of housestaff work.KEY WORDS: work sampling; time study; housestaff; computer. J GEN INTERN MED 1998;13:534-540.P olitical and economic forces are changing the inpatient work of housestaff. The Libby Zion case first drew public attention to residents' hours, resulting in legislation to curtail work hours. 1 Accrediting and professional organizations have also called for work limits to balance the requirements of patient service, education, and residents' personal lives. 2,3 As academic medical centers seek to contain costs, training is shifting from the more expensive hospital setting to outpatient clinics, leaving less time for inpatient training. 4,5 Initiatives to reduce the perceived physician surplus and correct the specialistgeneralist imbalance by regulating postgraduate training positions threaten...

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The On-Call Experience of Interns in Internal Medicine

Cited by 38 publications

References 9 publications

An observational study of emergency department intern activities

An observational study of emergency department intern activities

First‐postgraduate‐year Resident Clinical Time Use on Three Specialty Rotations

Analyzing the time and value of housestaff inpatient work

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