Nathalie Wenger, MD; Marie Méan, MD; Julien Castioni, MD; Pedro Marques-Vidal, MD, PhD; Gérard Waeber, MD; Antoine Garnier, MD, MBA
Presented in part at the first Swiss Society of General Internal Medicine Congress, Basel, Switzerland, 26 May 2016.
Note: Dr. Wenger affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Acknowledgment: The authors thank Olivier Pignolet, Information Technology Department, for supporting the study; Raphael Santos for developing the application; Dr. Marie-Angela Gagliano, Dr. Aude Giger, and Prof. Claudio Sartori for making substantial contributions to the conception of the study; and Milva Cappai and Marco Martinuz for helping in organization.
Financial Support: By the Information Technology Department and the Department of Internal Medicine of Lausanne University Hospital.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2238.
Reproducible Research Statement:Study protocol: Available from Dr. Wenger (e-mail, email@example.com). Statistical code: Available from Prof. Marques-Vidal (e-mail, firstname.lastname@example.org). Data set: Requests should be sent to Dr. Wenger (e-mail, email@example.com) and are conditional on a signed data transfer agreement. The source code for the application is available “as is” at https://github.com/agarnier00/MEDAY.
Requests for Single Reprints: Nathalie Wenger, MD, Department of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Wenger, Méan, Castioni, and Garnier: Department of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Prof. Marques-Vidal: Office BH10-642, Department of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Prof. Waeber: Office BH10-628, Department of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Author Contributions: Conception and design: N. Wenger, M. Méan, J. Castioni, G. Waeber, A. Garnier.
Analysis and interpretation of the data: N. Wenger, M. Méan, J. Castioni, P. Marques-Vidal, G. Waeber, A. Garnier.
Drafting of the article: N. Wenger, M. Méan, P. Marques-Vidal, G. Waeber, A. Garnier.
Critical revision of the article for important intellectual content: N. Wenger, M. Méan, J. Castioni, P. Marques-Vidal, A. Garnier.
Final approval of the article: N. Wenger, M. Méan, J. Castioni, P. Marques-Vidal, G. Waeber, A. Garnier.
Provision of study materials or patients: N. Wenger.
Statistical expertise: P. Marques-Vidal.
Obtaining of funding: N. Wenger, G. Waeber, A. Garnier.
Administrative, technical, or logistic support: N. Wenger, M. Méan, J. Castioni, G. Waeber, A. Garnier.
Collection and assembly of data: N. Wenger, M. Méan, J. Castioni, A. Garnier.
Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers.
To describe how residents allocate their time during day and evening hospital shifts.
Time and motion study.
Internal medicine residency at a university hospital in Switzerland, May to July 2015.
36 internal medicine residents with an average of 29 months of postgraduate training.
Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded.
Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m.
The study involved a small sample from 1 institution.
At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer.
Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.
Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts. Ann Intern Med. [Epub ahead of print 31 January 2017]166:579–586. doi: 10.7326/M16-2238
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Published: Ann Intern Med. 2017;166(8):579-586.
Published at www.annals.org on 31 January 2017
Education and Training, Hospital Medicine.
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