First-Year Residents Conduct Little Direct Patient Care

First-year residents training in internal medicine spend an average of 15.9 hours per 24-hour shift on indirect patient care, including activities such as documentation and interacting with electronic health records (EHRs), according to a JAMA Internal Medicine study.

Of the remaining time, just three hours per shift are spent on direct patient care and 1.8 hours on education. An average of 3.8 hours per 24-hour shift are spent multitasking.

For the study, which was conducted to understand how residents balance patient care and educational activities, researchers observed 80 first-year residents in six U.S. mid-Atlantic region internal medicine teaching programs over 2,173 hours.

“It is important to realize that the tasks done in the computer – entering orders, reviewing lab or imaging results, reading notes by consultant physicians, etc. – are still vital patient care activities,” Christopher Moriates, MD, associate chair for quality, safety, and value at Dell Medical School at the University of Texas at Austin, told Reuters. However, “more time spent on computers can potentially lead to a lack of building trusting relationships and connecting with patients on a humanistic level,” he cautioned.

The authors noted that their findings provide a baseline measure for future efforts designed to improve the workday structure and experience of internal medicine trainees.

Sources: Reuters, April 15, 2019; Chaiyachati KH, Shea JA, Asch DA, et al. Assessment of inpatient time allocation among first-year internal medicine residents using time-motion observations. JAMA Intern Med. 2019 April 15. [Epub ahead of print]