How residents spend their nights on call

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.