The Impact of Resident Duty Hours Reform on the Internal Medicine Core Clerkship: Results from the Clerkship Directors in Internal Medicine Survey

Kogan, Jennifer R.; Pinto-Powell, Roshini; Brown, Lin; Hemmer, Paul A.; Bellini, Lisa M.; Peltier, Deborah

doi:10.1097/01.acm.0000246873.04942.a8

Cited by 37 publications

(26 citation statements)

References 18 publications

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“…[4][5][6][7] As duty hour restrictions limit time to provide patient care, advance their own education, and teach students, residents may sacrifice teaching in an effort to address their other responsibilities. The majority of residents, 8,9 faculty, 10 and clerkship directors 11 perceived that the effects of the 2003 duty hour restrictions would leave residents with less time for teaching and possibly more negative attitudes toward teaching.…”

Section: Teaching Resident Role As Educatormentioning

confidence: 99%

“…17,18 Faculty, especially if heavily involved with student teaching, tend to believe that duty hour restrictions will threaten their attending role. 10,11,19 Concerns include less time available for teaching during rounds, less bedside teaching, 11 and an overall decline in the medical student educational experience post-duty hour restrictions. 10 Another concern is that duty hour restrictions may alter attending rounds' discussions to render them less educationally valuable for students.…”

Section: Rounds and The Role Of The Attending Physicianmentioning

confidence: 99%

“…This discontinuity could erode students' sense of ownership for their patients, thereby impairing their professional development. 11,22 Similarly, excessive shift work could erode a learner's work ethic and sense of responsibility to patients. 23 The actual impact of duty hour restrictions on student continuity with patients has been mixed.…”

Section: Discontinuity Shift Workmentioning

confidence: 99%

See 2 more Smart Citations

Educating Clerkship Students in the Era of Resident Duty Hour Restrictions

Nixon

Aiyer

Durning

et al. 2011

The American Journal of Medicine

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Section: Teaching Resident Role As Educatormentioning

confidence: 99%

Section: Rounds and The Role Of The Attending Physicianmentioning

confidence: 99%

Section: Discontinuity Shift Workmentioning

confidence: 99%

See 1 more Smart Citation

Educating Clerkship Students in the Era of Resident Duty Hour Restrictions

Nixon

Aiyer

Durning

et al. 2011

The American Journal of Medicine

Self Cite

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“…Duty-hour regulations have resulted in faculty and residents perceiving less time to teach students, reduced continuity of patient care, and decreased volume and variety of patient exposures for students. [8][9][10][11][12][13] Billing and medico-legal concerns have resulted in many institutions prohibiting students from using EHRs. 14 Medicine (APDIM) surveyed its members about the IM subinternship.…”

mentioning

confidence: 99%

The Internal Medicine Subinternship—Now More Important than Ever

Angus

Aronowitz

et al. 2015

J GEN INTERN MED

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“…Indeed, clerkship directors perceived that the 2003 resident duty hour regulations diminished students' experiences with teaching and feedback. 9 As with residents, attention to the quality of students' experience through redesign of teaching experiences, supervision and patient care interactions can enhance student education. 10 Attending physicians have also been affected by duty hour reform and may incur added responsibilities for patient care if resident shifts preclude their ability to provide safe, high-quality patient care.…”

mentioning

confidence: 99%

Counting Quality, Not Hours: Understanding the Impact of Duty Hour Reform on Internal Medicine Residency Education

Wayne¹,

Hauer

2012

J GEN INTERN MED

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O ne year ago, the Accreditation Council for Graduate Medical Education (ACGME) imposed new resident duty hour regulations that particularly affect the most junior postgraduate learners. 1 These requirements focus on enhanced supervision and oversight, and limit postgraduate year (PGY-1) residents to 16 hours of continuous duty. We expect data to emerge soon regarding the impact of the second round of duty hour reform on patient care outcomes. However, two articles in this issue of JGIM focus on the urgent need for medical educators to measure the nature and quality of resident learning and patient care activities in the context of reduced resident duty hours.The first article, by Fletcher et al., documents the activities of PGY-1 internal medicine residents during oncall periods. 2 The authors performed a prospective time and motion study on the general medicine wards of a Veterans Affairs Hospital affiliated with the Medical College of Wisconsin. Trained observers recorded activities of PGY-1 residents using customized task analysis software that divided work content into six categories: (1) direct patient care at the bedside; (2) computer work such as writing notes and orders; (3) communication with nurses or other physicians, (4) downtime; (5) transit; and (6) education and learning. Although on-call periods are assumed to be a robust opportunity for PGY-1 residents to assess and admit new patients, only 12 % of PGY-1 residents' time was spent in direct patient care, as compared to 40 % of time at the computer and 30 % in non-patient communication. Although conferences were not included, the authors found an alarmingly small amount of time-20 min-devoted to teaching from supervising residents and/or independent reading about patients.The second article by Gonzalo and colleagues examined compliance with 16 hours shifts during call periods. 3 The authors studied the 16 hours shift in 2010 (before the 2011 mandate) at Beth Israel Deaconess Medical Center. Using an electronic survey, residents were asked about shift length and numbers of new admissions. At least one team member exceeded 16 hours during 40 % of shifts. Not surprisingly, multiple admissions arriving near the end of the shift were associated with non-compliant extended shifts. However, the investigators also found that shifts with more than six total admissions per team had an adjusted odds ratio of 2.9 (95 % CI 1.05-8.3) for non-compliance. As these teams had two PGY-1 residents and a supervising PGY-2 or PGY-3 resident, this number of admissions is relatively modest, yet caused a significant amount of work hour non-compliance.Taken together, these studies paint a sobering picture of the current status of inpatient internal medicine residency education featuring periodic on-call admitting days. Although residents have been relieved of tasks thought to be of low learning value such as blood drawing and patient transport, computerized note writing and order entry currently demand much of their time. Remaining compliant with new duty hour requirement...

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The Impact of Resident Duty Hours Reform on the Internal Medicine Core Clerkship: Results from the Clerkship Directors in Internal Medicine Survey

Abstract: Internal medicine clerkship directors are concerned about the impact of resident duty hours reform on student education. Additional studies of this educational impact are needed.

Cited by 37 publications

References 18 publications

Educating Clerkship Students in the Era of Resident Duty Hour Restrictions

Educating Clerkship Students in the Era of Resident Duty Hour Restrictions

The Internal Medicine Subinternship—Now More Important than Ever

Counting Quality, Not Hours: Understanding the Impact of Duty Hour Reform on Internal Medicine Residency Education

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