You may be surprised and dismayed when you find out.
A study in the Journal of General Internal Medicine from a VA hospital affiliated with the University of Wisconsin reveals some startling facts.
During a 14-hour call period of 3 pm to 5 am, medical interns spent 40% of their time on computer work and 30% on “non-patient communication,” such as clinical conversations with team members, other physicians and nurses among other things. Direct patient care accounted for a whopping 12% of their time.
What about teaching and learning? Would you believe 2% of the time?
The study was conducted using observers trained in time-motion research. They followed the 25 interns who volunteered for the project, but did not interact with them or influence them in any way. The study was likely much more accurate than most previous research on this topic, which was based on self-reported surveys of house staff.
Other interesting tidbits from the paper were that the on-call intern cross-covered an average of 27 patients per night, which seems like a lot to me. The amount of time spent on “sign out” or “hand offs” was not stated. They averaged 4 admissions per night. Only 93 minutes [11% of the total time on call] were devoted to “downtime” — that is sleeping, eating and recreational computer time. So that’s about 1.5 hours for sleeping, eating and surfing the Internet.
So it looks like internal medicine interns at the VA in Wisconsin do a lot of “scut work” and don’t have much time for learning or sleeping. With only 4 admissions per night, you would think there might be more opportunity for sleep, but since this was internal medicine, each admission probably took two hours.
The interns in the study worked every fourth night. Ironically, in the good old days when we worked every second or third night, we cross-covered far fewer patients because there were more of us on call each night. Therefore, we got more sleep and were less tired the next day. As a matter of fact, I often got more sleep when I was on call than when I wasn’t. (I did a lot of … ah, reading when I wasn’t on call.)
When one looks at the small amount of time allotted to patient care, teaching and learning, one is not shocked that many graduates of residency these days are not confident about starting independent practice.
I suspect the results would be similar if surgical residents were observed.
Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 300,000 page views, and he has over 3,700 followers on Twitter.
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