title: A Time Study of Plastic Surgery Residents.
abstract: BACKGROUND
  Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center.
  
  
  METHODS
  Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting.
  
  
  RESULTS
  A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P < 0.0001); 57.7% of activities require 4 minutes or less, suggesting that resident work was highly fragmented. Residents spent 10.7% of their workdays waiting for other services.
  
  
  CONCLUSIONS
  In this first-time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we suggest that future changes to residency programs be pilot tested, with preimplantation and postimplementation time studies performed to quantify the changes' impact.
authors.affiliation: From the *Division of Plastic Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA †Divison of Plastic Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and ‡Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Lau
authors.forename: Indranil
authors.initials: I
authors.lastname: Sinha
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Elof
authors.initials: E
authors.lastname: Eriksson
mesh_terms: D000046:Academic Medical Centers; D001900:Boston; D004526:Efficiency; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D013518:Surgery, Plastic / Q000193:education*; D013995:Time; D014940:Work Schedule Tolerance / Q000523:psychology; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data*