title: In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time?
abstract: BACKGROUND
  The 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) common program requirements compress busy inpatient schedules and increase intern supervision. At the same time, interns wrestle with the effects of electronic medical record systems, including documentation needs and availability of an ever-increasing amount of stored patient data.
  
  
  OBJECTIVE
  In light of these changes, we conducted a time motion study to determine how internal medicine interns spend their time in the hospital.
  
  
  METHODS
  Descriptive, observational study on inpatient ward rotations at two internal medicine residency programs at large academic medical centers in Baltimore, MD during January, 2012.
  
  
  METHODS
  Twenty-nine interns at the two residency programs.
  
  
  METHODS
  The primary outcome was percent of time spent in direct patient care (talking with and examining patients). Secondary outcomes included percent of time spent in indirect patient care, education, and miscellaneous activities (eating, sleeping, and walking). Results were analyzed using multilevel regression analysis adjusted for clustering at the observer and intern levels.
  
  
  RESULTS
  Interns were observed for a total of 873 hours. Interns spent 12 % of their time in direct patient care, 64 % in indirect patient care, 15 % in educational activities, and 9 % in miscellaneous activities. Computer use occupied 40 % of interns' time. There was no significant difference in time spent in these activities between the two sites.
  
  
  CONCLUSIONS
  Interns today spend a minority of their time directly caring for patients. Compared with interns in time motion studies prior to 2003, interns in our study spent less time in direct patient care and sleeping, and more time talking with other providers and documenting. Reduced work hours in the setting of increasing complexity of medical inpatients, growing volume of patient data, and increased supervision may limit the amount of time interns spend with patients.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604, Baltimore, MD 21202, USA. lblock6@jhmi.edu
authors.forename: Lauren
authors.initials: L
authors.lastname: Block
authors.forename: Robert
authors.initials: R
authors.lastname: Habicht
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Desai
authors.forename: Kevin
authors.initials: K
authors.lastname: Wang
authors.forename: Kathryn Novello
authors.initials: KN
authors.lastname: Silva
authors.forename: Timothy
authors.initials: T
authors.lastname: Niessen
authors.forename: Nora
authors.initials: N
authors.lastname: Oliver
authors.forename: Leonard
authors.initials: L
authors.lastname: Feldman
mesh_terms: D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D005791:Patient Care / Q000379:methods / Q000592:standards*; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D017748:Time Management / Q000379:methods; D013996:Time and Motion Studies; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*