First-year doctors, or interns, spend nearly all (87 percent) of their time at work away from patients, half of which is spent interacting with electronic health records (EHRs), according to a new study from researchers at Penn Medicine and Johns Hopkins University.
And of the 13 percent of time spent interacting with patients face-to-face, much of that is still spent multitasking. Researchers say that this study, which was published this week in JAMA Internal Medicine, is the largest that has taken a look at how young doctors spend their work day. They sought to further understand what medical residents did while in training, such as how much time they spent in education and patient care.
The study analyzed data from six different internal medicine programs that took part in a previous study, a larger national effort that this latest research is part of, called the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) study.
For this current study, researchers recorded the activities of 80 interns over three months in 2016, gathering data on almost 200 shifts spanning nearly 2,200 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 EHR, communication with other clinicians, or viewing images; and education included studying and time spent being taught while in the hospital.
The findings revealed that 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.
What’s more, 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.
As researchers concluded, “Notably, more than 10 hours (43 percent) of a 24-hour period were spent interacting with the electronic medical record. In contrast, little time was spent in educational activities or direct patient care. When interns were engaged in these activities, indirect patient care often co-occurred.”
Krisda Chaiyachati, M.D., an assistant professor of Medicine in the Perelman School of Medicine of the University of Pennsylvania, noted that while interns are spending a significant amount of time not interacting directly with patients, it’s still too early to tell "whether or not how interns allocate their time is 'good' or 'bad.'"
At the same time, he believes that “indirect patient care has tradeoffs,” adding, “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."
The multi-year study, iCOMPARE, has been funded by the National Institute of Health (NIH) and the Accreditation Council for Graduate Medical Education (ACGME). It seeks to better understand the effects of shift lengths on young doctors and their patients.
