MedicalResearch.com Interview with:
Dresse Nathalie Wenger
Cheffe de clinique
FMH médecine interne
Département de Médecine Interne
CHUV – Lausanne
MedicalResearch.com: What is the background for this study?
Response: The structure of a residents’ working day dramatically changed during the last decades (limitation of working hours per week, wide implementation of electronic medical records (EMR), and growing volume of clinical data and administrative tasks), especially in internal medicine with increasing complexity of patients. Electronic Medical Records (EMR) have some positive effects but negative effects have been also described ie more time writing notes, more administrative works, and less time for communication between physicians and patients.
Few time motion studies have been published about the resident’s working day in Internal Medicine: the impact of the computer, and what really do the residents do during their work, especially the time spent with the patient versus the computer, as now the EMRs are widely implemented. Previous studies have been mostly performed in the US, so we decided to conduct one observational and objective study in Europe.
MedicalResearch.com: What are the main findings?
The chief findings, in accordance with the literature,are:
- residents do not fulfill their work in the scheduled time
- the activities indirectly related to the patient predominate
- and about half of the work day is spent with a computer
- residents spend almost three times more time with the computer than with patients.
MedicalResearch.com: What should readers take away from your report?
Response: Our study confirms that, as physicians, we are now in the “digital age”, with half of the working time on a computer. We don’t say that it’s bad or good, but we have to work with it, and there is an urgent need to improve electronic medical records, discharge residents of some administrative tasks which could be delegated, and rethink resident’s work organization, in order to increase efficiency to face highly complex inpatients and enhance the role of the physician.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Time motion studies are the preferred methodological type of study to assess physicians’ time allocation, compared to interview studies, with an objective estimation of the time dedicated to each activity.
So a study like ours would be a good idea to evaluate each hospital, and to evaluate impacts of changes with “before/after “studies. We have to rethink the organization of the resident’s work and educational program. In our hospital, we are currently working on it with an active working group. We have also already implemented a medical secretary to discharge resident from some administrative tasks, and we are working hard with the IT department to improve our EMR. We will repeat this time motion study after the changes to measure the impact.
It will be also interesting to compare different hospitals/organization by replicating this study. Another hospital in Switzerland has just completed it and we are waiting for the results.
MedicalResearch.com: Is there anything else you would like to add?
Response: The results of our study must not show a negative quality of care. The literature shows that in 1961 and 1971 (first time motion studies), residents spent the same proportion of time with their patients. But with the increasing complexity of inpatients, we need now better EMR and less administrative work for residents, in order to free up time to “think “about the patient care. So I hope this study will be a motivation to give us the means to change that.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts. Ann Intern Med. [Epub ahead of print 31 January 2017] doi: 10.7326/M16-2238
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