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The Composition of Intern Work While on Call

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ABSTRACT

BACKGROUND

The work of house staff is being increasingly scrutinized as duty hours continue to be restricted.

OBJECTIVE

To describe the distribution of work performed by internal medicine interns while on call.

DESIGN

Prospective time motion study on general internal medicine wards at a VA hospital affiliated with a tertiary care medical center and internal medicine residency program.

PARTICIPANTS

Internal medicine interns.

MAIN MEASURES

Trained observers followed interns during a “call” day. The observers continuously recorded the tasks performed by interns, using customized task analysis software. We measured the amount of time spent on each task. We calculated means and standard deviations for the amount of time spent on six categories of tasks: clinical computer work (e.g., writing orders and notes), non-patient communication, direct patient care (work done at the bedside), downtime, transit and teaching/learning. We also calculated means and standard deviations for time spent on specific tasks within each category. We compared the amount of time spent on the top three categories using analysis of variance.

KEY RESULTS

The largest proportion of intern time was spent in clinical computer work (40 %). Thirty percent of time was spent on non-patient communication. Only 12 % of intern time was spent at the bedside. Downtime activities, transit and teaching/learning accounted for 11 %, 5 % and 2 % of intern time, respectively.

CONCLUSION

Our results suggest that during on call periods, relatively small amounts of time are spent on direct patient care and teaching/learning activities. As intern duty hours continue to decrease, attention should be directed towards preserving time with patients and increasing time in education.

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Acknowledgements

Contributors: The authors wish to thank Amanda Grippen, Nathan Meyer, Andrew Kordus, Kimberly Spencer, Jessica Schmidt, Sherrie Smaxwill, Eric Porterfield, and Lance Trautman for their contributions to this project.

Funding/support

This study was funded by the VA HSRD, grant #PP0 09-259-01

Prior presentations

Part of this work was presented at the VA HSR&D meeting in Washington, DC in February 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Clement J. Zablocki VAMC, Milwaukee, WI, USA

    Kathlyn E. Fletcher MD, MA

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Kathlyn E. Fletcher MD, MA, Alexis M. Visotcky MS & Sergey Tarima PhD

  3. Vanderbilt University, Nashville, TN, USA

    Jason M. Slagle PhD & Matthew B. Weinger MD

  4. Tennessee Valley VAMC, Nashville, TN, USA

    Matthew B. Weinger MD

  5. Philadelphia VAMC, Philadelphia, PA, USA

    Marilyn M. Schapira MD, MPH

  6. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Marilyn M. Schapira MD, MPH

Authors
  1. Kathlyn E. Fletcher MD, MA
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  2. Alexis M. Visotcky MS
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  3. Jason M. Slagle PhD
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  4. Sergey Tarima PhD
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  5. Matthew B. Weinger MD
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  6. Marilyn M. Schapira MD, MPH
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Corresponding author

Correspondence to Kathlyn E. Fletcher MD, MA.

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ESM 1

Work categories and tasks associated with them. (DOC 64 kb)

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Fletcher, K.E., Visotcky, A.M., Slagle, J.M. et al. The Composition of Intern Work While on Call. J GEN INTERN MED 27, 1432–1437 (2012). https://doi.org/10.1007/s11606-012-2120-7

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  • DOI: https://doi.org/10.1007/s11606-012-2120-7

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