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First-year residents’ computer time outweighed time in front of patients

Internal medicine interns devoted 12% of their time to direct patient care compared with 40% of their time using computers in a recent study involving two residency programs.

Researchers at Johns Hopkins Medicine conducted an observational study of 29 first-year interns and their rotations at two academic medical centers in Baltimore. Twenty-two trained observers shadowed interns for a combined 873 hours during January 2012. They compared their results with similar time-motion studies that occurred before 2003 and again in 2011, when US hospitals were required to cap the number of consecutive hours residents could work.

Lauren Block

Accounting for every minute of the interns’ shifts by recording actions with an iPod Touch app, observers noted that interns spent 12% of their time examining or speaking with patients at bedside. By comparison, previous studies showed that interns spent 18% to 22% of their time at patients’ bedsides.

“One of the most important learning opportunities in residency is direct interaction with patients,” researcher Lauren Block, MD, MPH, fellow in the division of general internal medicine at the Johns Hopkins University School of Medicine, said in a press release. “Spending an average of 8 minutes a day with each patient just doesn’t seem like enough time to me.”

Sixty-four percent of the residents’ time was dedicated to indirect patient care, including researching patient history, placing orders, and conducting electronic forms some of which accounted for the 40% of time working at a computer. Residents spent 7% of their time walking and less than 1% of their time eating, sleeping and socializing.

“Interns in our study spent a minority of time directly caring for patients, and devoted nearly two-thirds of their time to indirect patient care,” the researchers concluded. “Reduced working hours … growing volume of patient data, and increased supervision may limit the amount of time interns spend with patients.

“Educators and policymakers should place attention on ways to maximize the amount of time interns are able to spend with patients.”