1. At a teaching hospital in Switzerland, internal medicine residents spent an average of 52.4% and 47.9% of the day shift and evening shift, respectively, on activities indirectly related to the patient and spent 28.0% and 39.4% of the day shift and evening shift, respectively, on activities directly related to the patient.
2. Residents spent an average of 44.9% and 43.7% of the day shift and evening shift, respectively, using the computer.
Evidence Rating Level: 3 (Average)
Study Rundown: In recent decades, the organization of a resident’s workday has changed markedly. Changes include work hour limitations and widespread use of electronic medical records (EMRs). This time and motion study sought to evaluate the type and length of activities that internal medicine residents carried out during their shifts. The authors focused on how much time was spent using a computer and interacting with patients. In a study of 36 internal medicine residents in a university hospital in Switzerland, the authors found that the residents worked for longer than their scheduled hours, spent most of their time on activities not directly related to patients, and used the computer for 44.9% (day shift) and 43.7% (evening shift) of their workday. The authors suggest that efficiency can be increased through structural changes as well as improvements in EMR.
Strengths of the study include a focus on computer usage, which is a factor that previous time and motion studies seldomly focused on. In addition, time and motion studies avoid the recall bias that may occur in interview studies that evaluate how much time physicians spend on various activities. Limitations of the study include the use of a single hospital and a small sample size, which may limit generalization of results. There is also possible observational bias because the physicians were aware that they were being observed.
In-Depth [time and motion study]: From May to July 2015, trained observers recorded the activities of 36 internal medicine residents for a total of 696.7 hours (49 day shifts and 17 evening shifts) at a teaching hospital in Switzerland. Residents were observed from the time of their arrival at work through the time of their departure. Twenty-two job-related activities were recorded in real time. Day shifts were observed to last an average of 1.6 hours more than the scheduled 10 hours, with after-hours being mostly spent filling out the EMR. Percentages of time spent during day shifts and evening shifts were calculated for 6 categories: indirectly related to the patient (52.4% and 47.9%, respectively), directly related to the patient (28.0% and 39.4%), academic (6.3% and 0.8%), nonmedical tasks (6.1% and 5.2%), transition time to next activity (5.1% and 5.1%), and communication (2.3% and 1.2%). On average, residents during day shifts spent 1.7 hours with patients and 5.2 hours on the computer. In general, residents spent 5 times as many hours on other tasks as they did with patients.
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