Nav: Home

First-year doctors spend almost 90% of their time away from patients

April 15, 2019

First-year doctors, or interns, spend 87 percent of their work time away from patients, half of which is spent interacting with electronic health records, according to a new study from researchers at Penn Medicine and Johns Hopkins University. Of the 13 percent of time spent interacting with patients face-to-face, much of that is still spent multitasking. As the largest study to look at how young doctors spend their work day, this research sought to understand what medical residents did while in training, such as how much time they spent in education and patient care. The study was published today in JAMA Internal Medicine.

"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 in 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."

Attempting to gauge the time doctors-in-training spend during their shifts, this research is a part of a larger effort known as the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) study. This multi-year study, funded by the National Institute of Health (NIH) and the Accreditation Council for Graduate Medical Education (ACGME), seeks to better understand the effects of shift lengths on young doctors and their patients.

Last month, two other studies published in the New England Journal of Medicine from iCOMPARE showed that first-year doctors did not experience chronic sleep loss nor was patient safety affected when doctors-in-training were allowed to work longer shifts than had previously been permitted by the ACGME.

The current study analyzed data from six different internal medicine programs that took part in the national iCOMPARE study. Researchers recorded the activities of 80 interns over three months in 2016, gathering data on 194 shifts spanning 2,173 hours. All activities were classified into categories, including direct patient care, indirect patient care, and education. Direct patient care included time when the interns spoke directly with patients or their family; indirect patient care involved things like working in the medical record, communication with other clinicians, or viewing images; and education included studying and time spent being taught while in the hospital.

Interns spent the most time performing indirect patient care, taking up an average of 15.9 hours of a 24-hour period--almost five times more hours than the next most common activity, direct patient care, which accounted for three hours of the day. Education was the third-highest category of intern time, attributed to 1.8 hours.

Although interns are spending a significant amount of time not interacting directly with patients, Chaiyachati added that it's too early to tell "whether or not how interns allocate their time is 'good' or 'bad.'" That could come with further research into how time spent on these shifts affects patient care or physician well-being.

"Indirect patient care has tradeoffs," Chaiyachati said. "If it takes time away to the point that patients feel like we aren't listening to their needs or we lose out on human interactions that provide physicians with a sense of purpose, that is a bad thing. But if it helps us diagnose diseases more efficiently, then maybe that's not that bad in the end."

When the researchers analyzed four different time periods (separated into six-hour periods: morning, afternoon, evening, and night), they found no significant differences. But multitasking was common throughout. Roughly 25 percent of interns' time interacting with patients occurred at the same time as coordinating care or updating medical records.

"I think increased multitasking is a side effect of our current system," Chaiyachati said. "It's not simply that we are doing more work or we have more tasks in our day-to-day. We are trying to do more in a fixed amount of time."

Researchers note that this study can provide an important baseline that training programs and hospitals may use when adjusting programs, shifting responsibility for tasks to other health care providers, or automating processes. In that vein, the iCOMPARE team is continuing to comb through its data to find clues about how the work day could change so that doctors in training experience less burnout or improve their professional satisfaction while in training.
-end-
Funding for this study was provided by the NIH's National Heart, Lung and Blood Institute and ACGME (grants U01HL126088 and U01HL125388, respectively).

The paper's senior author is Sanjay Desai, MD, director of the Osler Medical Training Program and an associate professor of Medicine at Johns Hopkins University. Other Penn Medicine authors on this study include Judy A. Shea, David A. Asch, Manquing Liu, Lisa Bellini, Jessica Dine, Yevgeniy Gitelman, Alyssa Yeager, and Jeremy Asch.

University of Pennsylvania School of Medicine

Related Education Articles:

The new racial disparity in special education
Racial disparity in special education is growing, and it's more complex than previously thought.
Education may be key to a healthier, wealthier US
A first-of-its-kind study estimate the economic value of education for better health and longevity.
How education may stave off cognitive decline
Prefrontal brain regions linked to higher educational attainment are characterized by increased expression of genes involved in neurotransmission and immunity, finds a study of healthy older adults published in JNeurosci.
Does more education stem political violence?
In a study released online today in Review of Educational Research, a peer-reviewed journal of the American Educational Research Association, three Norwegian researchers attempt to bring clarity to this question by undertaking the first systematic examination of quantitative research on this topic.
Education interventions improve economic rationality
This study proves that education can be leveraged as a tool to help enhance an individual's economic decision-making quality, or economic rationality.
Protestantism still matters when it comes to education, study shows
A new academic study, the first of its kind, reveals a significant and positive historical legacy of Protestant religion in education around the world.
Individual education programs not being used as intended in special education
Gone are the days when students with disabilities were placed in a separate classroom, or even in a completely different part of the school.
How does limited education limit young people?
A recent nationally-representative US Department of Education study found that 28 percent of fall 2009 ninth-graders had not yet enrolled in a trade school or college by February 2016 -- roughly six-and-a-half years later.
'Depression education' effective for some teens
In an assessment of their 'depression literacy' program, which has already been taught to tens of thousands, Johns Hopkins researchers say the Adolescent Depression Awareness Program (ADAP) achieved its intended effect of encouraging many teenagers to speak up and seek adult help for themselves or a peer.
Teenagers gamble away their education
The odds are stacked against teenagers who regularly gamble. A new study in Springer's Journal of Gambling Studies shows that a 14-year-old who gambles is more likely to struggle at school.
More Education News and Education Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.