First-year medical residents spend little time on patient care


By Lisa Rapaport

(Reuters Health) - Over a typical 24-hour shift, first year residents training in internal medicine spend just three hours on direct patient care and only 1.8 hours on education, a U.S. study suggests.

Most of their time - an average of 15.9 hours out of every 24-hour shift - is consumed instead by "indirect patient care," primarily involving interactions with medical records and documentation, the study found.

"Even when interns were face-to-face with patients, much of it was spent multitasking - interacting with the electronic health record or coordinating care with other health care workers," said lead study author Dr. Krisda Chaiyachati of the University of Pennsylvania Perelman School of Medicine in Philadelphia.

"Based on evidence and my own personal experiences, multitasking makes it difficult to complete any of these individual tasks well," Chaiyachati said by email. "When doctors are multitasking, at minimum, we are creating inefficiencies in how we manage sick patients, and, hopefully, we are not creating mistakes that lead to harm."

The U.S. spends more than $12 billion annually on graduate medical education, researchers noted online April 15 in JAMA Internal Medicine. Despite this considerable investment, research to date hasn't offered a clear picture of how residents balance patient care and educational activities.

For the current study, researchers observed 80 interns from six mid-Atlantic teaching programs over 2,173 hours. On half of the shifts, observers watched interns for at least 10.5 hours.

Observers sorted interns' activities into several categories: education; going on patient rounds; work duties like doing procedures or updating medical records; transferring patient care to other providers; direct care like communicating with patients or families or doing evaluations; indirect care like reviewing lab results or medical records; or miscellaneous things like food or bathroom breaks.

Trainee physicians spent little time on direct patient care across all shifts, the study found.

They spent an average of 3.8 hours of a typical 24-hour period multi-tasking.

Using computers and dealing with electronic medical records while caring for patients might not always be a bad thing, said Dr. Christopher Moriates, associate chair for quality, safety and value at Dell Medical School at the University of Texas at Austin.

"It is important to realize that the tasks done in the computer - entering orders, reviewing lab or imaging results, reading notes by consultant physicians, etc. - are still vital patient care activities," Moriates, author of an accompanying editorial, said by email.

"Simply put, as more of these tasks (which physicians have always performed) are done electronically, more time will be spent with the computer," Moriates said. "Just like how most people spend more time reading news on a computer or phone now rather than in newsprint, physicians spend more time performing tasks electronically."

That said, care of the patient is still dependent on actually being present with patients, talking to them about their symptoms and medical histories, and examining them carefully, all of which cannot be done electronically, Moriates added.

"More time spent on computers can potentially lead to a lack of building trusting relationships and connecting with patients on a humanistic level," Moriates said. "Most physicians went in to medicine to treat patients, not enter orders and notes in computers, so we need to ensure we strike an adequate balance of spending direct time with patients and performing the necessary tasks in electronic health records to provide for appropriate care."


JAMA Intern Med 2019.

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