MedicalResearch.com Interview with:
Krisda Chaiyachati, MD, MPH, MSHP
Medicine, Perelman School of Medicine
Clinical Innovation Manager
Penn’s Center for Health Care Innovation
Perelman School of Medicine
Medical Director, Penn Medicine’s FirstCall Virtual Care
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The United States spends more than $12 billion annually on training young doctors who have rates of burnout and depression at an alarmingly high rate. Yet, we have limited evidence as to what they are doing while training in the hospital. We sought to glimpse into how their day is spent. In the largest study to date, we observed 80 first-year internal medicine physicians (“interns”) for nearly 2200 hours across 194 work shifts at 6 different sites. Our research sought to understand what medical residents did by categorizing training activities into themes such as time spent in education or patient care.
MedicalResearch.com: What should readers take away from your report?
Response: We believe our findings reveal a previously hidden picture of how young physicians are trained, and the reality of medical practice today. Interns spend 87 percent of their work time away from patients, half of that time being spent interacting with electronic health records. Of the 13 percent of time spent with patients face-to-face, much of it is spent multitasking in other activities such as interacting with the electronic health record and coordinating care with other health care workers.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Although interns are spending a significant amount of time not interacting directly with patients, our study is not designed to tell us whether or not this allocation of time is a “good” or “bad” signal. That could come with further research into how time spent on these shifts affects patient care or physician well-being.
Indirect patient care has tradeoffs. If it takes time away to the point that patients feel like we aren’t listening to their needs or we lose out on human interactions that provide physicians with a sense of purpose, that is a bad thing. But if it helps us diagnose diseases more efficiently, then maybe that’s not that bad in the end.
At minimum, we believe our study can help residency program leaders take stock of what their interns are doing and consider whether the time and processes are right for developing the physicians we need tomorrow.
Chaiyachati KH, Shea JA, Asch DA, et al. Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations. JAMA Intern Med. Published online April 15, 2019. doi:10.1001/jamainternmed.2019.0095
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