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How residents spend their nights on call.
S S Moore1, M D Nettleman, S Beyer
1Division of General Medicine, Department of Internal Medicine, Virginia Commonwealth, Richmond, VA 23298-0102, USA.
Summary
Internal medicine and pediatrics residents spent more time on chart review and documentation than on direct patient care during night calls. This study highlights the significant time allocation to administrative tasks over patient interaction in resident education.
Area of Science:
- Medical Education
- Internal Medicine
- Pediatrics
Background:
- Night call is a crucial component of resident training in medicine and pediatrics.
- Limited data exists on the specific activities undertaken by residents during night call rotations.
Purpose of the Study:
- To quantify and categorize the activities of internal medicine and pediatrics residents during night call.
- To compare the time allocation across different tasks for residents in these two specialties.
Main Methods:
- Trained observers accompanied on-call residents in internal medicine and pediatrics.
- Activities and their durations were recorded during night shifts (7 PM to 7 AM) over June and July 1997.
- Data was collected at an urban academic medical center.
Main Results:
- Residents spent an average of 5.3-5.7 hours on non-clinical activities (eating, resting, sleeping) and 2.2-2.6 hours on chart review and documentation per night.
- Time spent with patients (history, physicals, new patients) was less than time spent on documentation.
- Pediatrics residents dedicated more time to procedures (37 min) than internal medicine residents (14 min).
Conclusions:
- Residents allocated a significant portion of their night call time to chart review and documentation, exceeding time spent with patients.
- The educational value and impact on patient outcomes of this extensive documentation time remain unclear.
- Findings suggest a need to re-evaluate the balance between administrative duties and patient-centered activities in resident education.