Documenting or Operating: Where Is Time Spent in General Surgery Residency?

Area of Science:

• Medical Informatics
• Surgical Education
• Health Services Research

Background:

• Electronic health records (EHR) are integral to physician workflows for documentation and information retrieval.
• The time commitment of surgical residents to EHR systems requires further investigation, especially concerning its impact on training and workload.

Purpose of the Study:

• To quantify the time general surgery residents spend using EHR systems.
• To assess the relationship between EHR usage duration and surgical case volume among residents.

Main Methods:

• Retrospective analysis of de-identified EHR login/logout data from general surgery residents (Clinical Years 1-5) over a 10-month period.
• Utilized time series analysis, Fisher's exact test, Wilcoxon rank sum test, linear mixed-effects models, and Pearson's correlation coefficient to analyze EHR usage and its association with case logs.

Main Results:

• General surgery residents spent a median of 2.4 hours/day and 23.7 hours/week on EHR tasks, representing at least 30% of their work hours.
• A significant portion of EHR time, particularly for interns, occurred outside scheduled duty hours (27% for day rotations, 7% for night rotations).
• No significant overall correlation was found between monthly operative case logs and EHR usage time (r=0.06, p=0.30), though a negative correlation was observed in second-year residents (r=-0.2, p=0.038).

Conclusions:

• General surgery residents allocate a substantial amount of time to EHR utilization, often extending beyond their official shifts.
• The lack of correlation between EHR time and case volume suggests that current documentation requirements may not fully capture the total effort associated with surgical procedures.
• Understanding EHR time burden is crucial for developing strategies to mitigate resident burnout and improve charting efficiency.