Overnight activities of medical students on call: is it really educational?

To validate self-report of activities and to assess time allocation of medical students taking in-house call during their third-year surgery clerkship.

Informed consent was obtained from students who agreed to participate while rotating on the third-year surgery clerkship. Students were randomized to 1 of 2 groups, either the self-report group or the shadow group. All students kept a log of their activities during weekdays. Students randomized to the self-report group kept a log of their activities on nights (6 pm to 7 am weeknights) and weekends (7 am to 7 am Saturday and Sunday) when they were assigned to in-house call. Students randomized to the shadow group kept a log of their activities and also were shadowed while on call by a research assistant (observer) who recorded their activities. All students categorized each activity as patient-care activities related to educational objectives (educational), patient-care activities unrelated to educational objectives (noneducational), and personal care (personal). To validate self-report, student and observer logs were compared. Percentages of time engaged in educational versus other activities were compared between the shadowed and nonshadowed groups and among weekdays (WD), weeknights (WN), weekend days (WED), and weekend nights (WEN).

A total of 34 students (16 shadow, 18 self-report) agreed to participate. Five (15%) students, all in the self-report group, did not turn in their logs. Data were available for the remaining 29 students for 138 shifts (WD, 44; WN, 46; WED, 24; WEN, 24). Observer and self-report were correlated highly for educational and personal activities, but not for noneducational activities. On WD, students averaged 76.1% of their time in educational activities, compared with 46.7%, 63.3%, and 50.2% of their time while on WN, WED, and WEN, respectively (P <.05 for WD vs. all others). Students spent between 9% and 14% of their time in noneducational activities, and between 9% and 49% of their time in personal activities during call shifts.

This study validates student self-report of activities while on surgery call. Students spend significantly more time engaged in educational activities during weekdays than any call shifts (weeknights, weekend days, weekend nights). This information can be used for curricular planning.