Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations.
BACKGROUND
Little is known about the impact of resident duty-hour regulations on the inpatient teaching experience.


OBJECTIVE
Provide descriptive information on the effect of resident duty-hour regulations on attendings and the educational environment.


METHODS
Qualitative analysis of attending focus groups and e-mail survey of residents in Internal Medicine.


METHODS
Inpatient attending physicians at 2 academic centers and residents at the affiliated university-based Internal Medicine residency program in Portland, OR.


RESULTS
Seventy-two percent of eligible attendings participated in 2 focus groups. Three themes were generated: increased clinical role, altered time management, and altered teaching. Attending physicians report performing more clinical work, teaching less, using more focused teaching methods, and experiencing an increased perception of intensity. Forty percent of eligible residents completed our e-mail survey. We organized residents data using the same 3 themes as attending physician data. Residents observed attending physicians performing increased clinical work, being more time aware, delivering more focused teaching, and having less time to teach. Participants noted changes in autonomy and professionalism. Strategies to enhance teaching effectiveness in the new environment were described.


CONCLUSIONS
Duty-hour regulations have increased attending clinical responsibility and decreased teaching time in 1 residency program, leading to the perception of a more intense attending experience. Duty-hour regulations encourage educators to determine what is critical to preserve in the educational experiences of learners and challenge us to reexamine autonomy and professionalism in training.
Harrison
Rebecca
R
Division of Hospitalist Medicine, Oregon Health & Science University, Portland, OR 97239, USA. harrisor@ohsu.edu
Allen
Elizabeth
E
D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D009922:Oregon; D013663:Teaching / Q000379:methods / Q000592:standards; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*