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In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?

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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.

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Acknowledgements

Funding

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.

Prior Presentations

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.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604, Baltimore, MD, 21202, USA

    Lauren Block MD, MPH, Albert W. Wu MD, MPH, Timothy Niessen MD, MPH & Leonard Feldman MD

  2. Division of General Internal Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N13W46, Baltimore, MD, USA

    Robert Habicht MD & Kathryn Novello Silva MD

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 653, Baltimore, MD, 21205, USA

    Albert W. Wu MD, MPH

  4. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St., Room 9042, Baltimore, MD, 21202, USA

    Sanjay V. Desai MD

  5. Johns Hopkins University, Baltimore, MD, USA

    Kevin Wang

  6. Division of General Internal Medicine, Johns Hopkins University, 600 North Wolfe Street, Nelson 215, Baltimore, MD, 21287, USA

    Timothy Niessen MD, MPH & Leonard Feldman MD

  7. University of Maryland Medical Center, 600 North Wolfe Street, Nelson 215, Baltimore, MD, 21287, USA

    Nora Oliver MD, MPH

Authors
  1. Lauren Block MD, MPH
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Corresponding author

Correspondence to Lauren Block MD, MPH.

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Block, L., Habicht, R., Wu, A.W. et al. In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?. J GEN INTERN MED 28, 1042–1047 (2013). https://doi.org/10.1007/s11606-013-2376-6

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