Internal Medicine Residents' Perceived Ability to Direct Patient Care: Impact of Gender and Experience

Abstract Background Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit. Methods The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit. Results Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care. Conclusions This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.

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Internal Medicine Residents' Computer Use in the Inpatient Setting

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00026.1 ◽

2012 ◽

Vol 4 (4) ◽

pp. 529-532 ◽

Cited By ~ 10

Author(s):

Amy S. Oxentenko ◽

Chinmay U. Manohar ◽

Christopher P. McCoy ◽

William K. Bighorse ◽

Furman S. McDonald ◽

...

Keyword(s):

Internal Medicine ◽

Patient Care ◽

Computer Use ◽

Hospital Setting ◽

Direct Patient Care ◽

Inpatient Setting ◽

Work Redesign ◽

General Internal ◽

Internal Medicine Residents ◽

Computer Based

Abstract Background Studies have suggested that patient contact time for internal medicine residents is decreasing and being replaced with computer-related activities, yet objective data regarding computer use by residents are lacking. Objective The aim of this study was to objectively measure time use by internal medicine residents while on duty in the hospital setting using real-time, voice-capture technology. Methods First- and third-year categoric internal medicine residents participated (n = 25) during a 3-month period in 2010 while rotating on general internal medicine rotations. Portable speech-recognition technology was used to record residents' activities. The residents were prompted every 15 minutes from an earpiece and asked to categorize the activity they had been doing since the last prompt, choosing from a predetermined list of 15 activities. Results Of the 1008 duty-time responses, 493 (49%) were classified as computer-related activities, whereas 341 (34%) were classified as direct patient care, 110 (11%) were classified as noncomputer-related education, and 64 (6%) were classified as other activities. Of resident reported computer-use time, 70% was spent on patient notes and order entry. Conclusions The results of our study suggest that computer use is the predominant activity for internal medicine residents while in the inpatient setting. Work redesign because of duty hour regulations should consider how to free up residents' time from computer-based activities to allow residents to engage in more direct patient care and noncomputer-based learning.

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Philip S. Hench’s Rheumatology Axiomatic Generalizations: Table 1.

The Journal of Rheumatology ◽

10.3899/jrheum.110606 ◽

2011 ◽

Vol 38 (12) ◽

pp. 2664-2670

Author(s):

GENE G. HUNDER ◽

LEROY GRIFFING

Keyword(s):

Internal Medicine ◽

United States ◽

Patient Care ◽

Education Program ◽

Mayo Clinic ◽

The United States ◽

Internal Medicine Residents ◽

The Status ◽

Rheumatology Education ◽

Unique Part

Philip S. Hench, MD, the first Mayo Clinic rheumatologist, came to Mayo Clinic in 1921. Because of his efforts in patient care, education, and research, and those of his colleagues, Mayo Clinic has been considered the first academic rheumatology center established in the United States. An early, popular lecture he gave to the internal medicine residents was an important and unique part of the rheumatology education program and was entitled “Axiomatic Generalizations Useful in the Diagnosis of Rheumatic Diseases.” We review the axioms in light of the status of rheumatology in the 1920s and 1930s when they were written, and assess their relevance today, 70 to 80 years later.

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Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool

BMJ Open ◽

10.1136/bmjopen-2019-033021 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033021

Author(s):

Simon Martin Frey ◽

Marie Méan ◽

Antoine Garnier ◽

Julien Castioni ◽

Nathalie Wenger ◽

...

Keyword(s):

Internal Medicine ◽

Time Allocation ◽

Postgraduate Training ◽

Working Time ◽

University Hospital ◽

Direct Patient Care ◽

Time Motion ◽

Internal Medicine Residents ◽

Working Day ◽

Hospital Comparison

ObjectivesThe vast majority of residents’ working time is spent away from patients. In hospital practice, many factors may influence the resident’s working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident’s working day structure in university and non-university hospital settings.DesignTwo separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer).SettingInternal medicine residencies at a university (May–July 2015) and a non-university (September–October 2016) community hospital.Participants28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital.OutcomesTime spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals.ResultsCumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179–211, 27.9%) and 116 min (IQR 98–134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively.ConclusionsWe successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

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Concerns and Recommendations of Internal Medicine Residents in HIV Patient Care in the Second Decade of the AIDS Epidemic in Taiwan

The Kaohsiung Journal of Medical Sciences ◽

10.1016/s1607-551x(09)70248-7 ◽

2004 ◽

Vol 20 (10) ◽

pp. 492-500

Author(s):

Ping-Chuan Hsiung ◽

Yun-Fang Tsai

Keyword(s):

Internal Medicine ◽

Patient Care ◽

Aids Epidemic ◽

Internal Medicine Residents

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Warnings in early narrative assessment that might predict performance in residency: signal from an internal medicine residency program

Perspectives on Medical Education ◽

10.1007/s40037-021-00681-w ◽

2021 ◽

Author(s):

Matthew Kelleher ◽

Benjamin Kinnear ◽

Dana R. Sall ◽

Danielle E. Weber ◽

Bailey DeCoursey ◽

...

Keyword(s):

Internal Medicine ◽

Patient Care ◽

Assessment Data ◽

Resident Performance ◽

Narrative Assessment ◽

Internal Medicine Residents ◽

Big Picture ◽

Normative Comparisons ◽

Inductive Thematic Analysis ◽

Attention To Detail

Abstract Introduction Narrative assessment data are valuable in understanding struggles in resident performance. However, it remains unknown which themes in narrative data that occur early in training may indicate a higher likelihood of struggles later in training, allowing programs to intervene sooner. Methods Using learning analytics, we identified 26 internal medicine residents in three cohorts that were below expected entrustment during training. We compiled all narrative data in the first 6 months of training for these residents as well as 13 typically performing residents for comparison. Narrative data were blinded for all 39 residents during initial phases of an inductive thematic analysis for initial coding. Results Many similarities were identified between the two cohorts. Codes that differed between typical and lower entrusted residents were grouped into two types of themes: three explicit/manifest and three implicit/latent with six total themes. The explicit/manifest themes focused on specific aspects of resident performance with assessors describing 1) Gaps in attention to detail, 2) Communication deficits with patients, and 3) Difficulty recognizing the “big picture” in patient care. Three implicit/latent themes, focused on how narrative data were written, were also identified: 1) Feedback described as a deficiency rather than an opportunity to improve, 2) Normative comparisons to identify a resident as being behind their peers, and 3) Warning of possible risk to patient care. Discussion Clinical competency committees (CCCs) usually rely on accumulated data and trends. Using the themes in this paper while reviewing narrative comments may help CCCs with earlier recognition and better allocation of resources to support residents’ development.

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Time is of the essence: an observational time-motion study of internal medicine residents while they are on duty

Canadian Medical Education Journal ◽

10.36834/cmej.36948 ◽

2017 ◽

Vol 8 (3) ◽

pp. e49-70

Author(s):

Cameron Leafloor ◽

Erin (Yiran) Liu ◽

Cathy Code ◽

Heather Lochnan ◽

Erin Keely ◽

...

Keyword(s):

Internal Medicine ◽

Information Transfer ◽

Observation Time ◽

Direct Patient Care ◽

Self Directed Learning ◽

Time Motion ◽

Motion Study ◽

Internal Medicine Residents ◽

Communication Time ◽

Duty Time

Background: The effects of changes to resident physician duty hours need to be measureable. This time-motion study was done to record internal medicine residents’ workflow while on duty and to determine the feasibility of capturing detailed data using a mobile electronic tool.Methods: Junior and senior residents were shadowed by a single observer during six-hour blocks of time, covering all seven days. Activities were recorded in real-time. Eighty-nine activities grouped into nine categories were determined a priori.Results: A total of 17,714 events were recorded, encompassing 516 hours of observation. Time was apportioned in the following categories: Direct Patient Care (22%), Communication (19%), Personal tasks (15%), Documentation (14%), Education (13%), Indirect care (11%), Transit (6%), Administration (0.6%), and Non-physician tasks (0.4%). Nineteen percent of the education time was spent in self-directed learning activities. Only 9% of the total on duty time was spent in the presence of patients. Sixty-five percent of communication time was devoted to information transfer. A total of 968 interruptions were recorded which took on average 93.5 seconds each to service.Conclusion: Detailed recording of residents’ workflow is feasible and can now lead to the measurement of the effects of future changes to residency training. Education activities accounted for 13% of on-duty time.

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Using the American Board of Internal Medicine Practice Improvement Modules to Teach Internal Medicine Residents Practice Improvement

Journal of Graduate Medical Education ◽

10.4300/jgme-d-09-00032.1 ◽

2010 ◽

Vol 2 (1) ◽

pp. 90-95 ◽

Cited By ~ 14

Author(s):

Rebecca Shunk ◽

Maya Dulay ◽

Kathy Julian ◽

Patricia Cornett ◽

Jeffrey Kohlwes ◽

...

Keyword(s):

Internal Medicine ◽

Patient Care ◽

Team Approach ◽

Self Assessment ◽

Continuity Clinic ◽

Residency Programs ◽

Practice Improvement ◽

Internal Medicine Residents ◽

Group Projects

Abstract Background Although residency programs must prepare physicians who can analyze and improve their practice, practice improvement (PI) is new for many faculty preceptors. We describe the pilot of a PI curriculum incorporating a practice improvement module (PIM) from the American Board of Internal Medicine for residents and their faculty preceptors. Methods Residents attended PI didactics and completed a PIM during continuity clinic and outpatient months working in groups under committed faculty. Results All residents participated in PI group projects. Residents agreed or strongly agreed that the projects and the curriculum benefited their learning and patient care. A self-assessment revealed significant improvement in PI competencies, but residents were just reaching a “somewhat confident” level. Conclusion A PI curriculum incorporating PIMs is an effective way to teach PI to both residents and faculty preceptors. We recommend the team approach and use of the PIM tutorial approach especially for faculty.

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Internal Medicine Residents’ Perspectives on Effects of 2011 ACGME Work Hour Regulations on Patient Care

Teaching and Learning in Medicine ◽

10.1080/10401334.2014.910458 ◽

2014 ◽

Vol 26 (3) ◽

pp. 274-278 ◽

Cited By ~ 1

Author(s):

Sumedh S. Hoskote ◽

Girish N. Nadkarni ◽

Narender Annapureddy ◽

Aneesha A. Shetty ◽

Ethan D. Fried

Keyword(s):

Internal Medicine ◽

Patient Care ◽

Internal Medicine Residents ◽

Work Hour

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Expanding Telehealth Competencies in Primary Care: A Longitudinal Interdisciplinary Simulation to Train Internal Medicine Residents in Complex Patient Care

Journal of Graduate Medical Education ◽

10.4300/jgme-d-20-00030.1 ◽

2020 ◽

Vol 12 (6) ◽

pp. 745-752

Author(s):

Rachel Wong ◽

Patricia Ng ◽

Tracey Spinnato ◽

Erin Taub ◽

Amit Kaushal ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Patient Care ◽

Primary Care Providers ◽

Interdisciplinary Care ◽

Care Providers ◽

Coordinated Care ◽

Post Intervention ◽

Complex Patient ◽

Internal Medicine Residents

ABSTRACT Background Despite increasing use of telehealth, there are limited published curricula training primary care providers in utilizing telehealth to deliver complex interdisciplinary care. Objective To describe and evaluate a telehealth curriculum with a longitudinal objective structured clinical examination (OSCE) to improve internal medicine residents' confidence and skills in coordinating complex interdisciplinary primary care via televisits, electronic consultation, and teleconferencing. Methods In 2019, 56 first- and third-year residents participated in a 3-part, 5-week OSCE training them to use telehealth to manage complex primary care. Learners conducted a standardized patient (SP) televisit in session 1, coordinated care via inter-visit e-messaging, and led a simulated interdisciplinary teleconference in session 2. Surveys measured confidence before session 1 (pre), post-session 1 (post-1), and post-session 2 (post-2). SP televisit checklists and investigators' assessment of e-messages evaluated residents' telehealth skills. Results Response rates were pre 100%, post-1 95% (53 of 56), and post-2 100%. Post-intervention, more residents were “confident/very confident” in adjusting their camera (33%, 95% CI 20–45 vs 85%, 95% CI 75–95, P < .0001), e-messaging (pre 36%, 95% CI 24–49 vs post-2 80%, 95% CI 70–91, P < .0001), and coordinating interdisciplinary care (pre 35%, 95% CI 22–47 vs post-2 84%, 95% CI 74–94, P < .0001). More residents were “likely/very likely” to use telemedicine in the future (pre 56%, 95% CI 43–69, vs post-2 79%, 95% CI 68–89, P = .001). Conclusions A longitudinal, interdisciplinary telehealth simulation is feasible and can improve residents' confidence in using telemedicine to provide complex patient care.

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