A Time—Motion Study of the Activities of Attending Physicians in an Internal Medicine and Internal Medicine—Pediatrics Resident Continuity Clinic

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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Management of chronic nonmalignant pain: A needs assessment in an Internal Medicine Resident Continuity Clinic

Journal of Opioid Management ◽

10.5055/jom.2008.0026 ◽

2018 ◽

Vol 4 (4) ◽

pp. 201 ◽

Cited By ~ 20

Author(s):

Leanne M. Yanni, MD ◽

Michael F. Weaver, MD ◽

Betty A. Johnson, MD, PhD ◽

Laura A. Morgan, PharmD ◽

Sarah E. Harrington, MD ◽

...

Keyword(s):

Internal Medicine ◽

Needs Assessment ◽

Management Practices ◽

Pain Clinic ◽

Drug Misuse ◽

Continuity Clinic ◽

Improvement Project ◽

Nonmalignant Pain ◽

Chronic Nonmalignant Pain ◽

Resident Continuity Clinic

Introduction: The authors hypothesized that Internal Medicine (IM) residents experience a lack of preparation, confidence, and reward when managing patients with chronic nonmalignant pain (CNMP) in their continuity clinic and that they exhibit deficiencies in CNMP management practices, particularly when opioids are prescribed.Methods: As part of a quality improvement project in the IM resident continuity clinic, the authors performed a needs assessment through a self-administered resident questionnaire and a retrospective chart review.Results: Fifty-seven percent of respondents rated their CNMP preparation as “fair” or “poor,” 89 percent reported that their experience was “much less” or “somewhat less” rewarding than managing patients with other chronic conditions, and 58 percent reported that CNMP management “negatively” or “very negatively” affected their view of primary care as a career. Twenty-eight charts of patients receiving opioids during a 1-year study period were reviewed. Although residents were likely to document pain diagnoses (93 percent) and pain scores (82 percent) as well as utilize medication agreements (82 percent), they were less likely to document illicit substance use (39 percent), document legal history (32 percent), or obtain prior medical records (39 percent). Few urine drug screens were ordered (18 percent) and 25 percent of patients had fewer than four face-to-face visits during the year.Discussion: The questionnaire indicated that IM residents lack preparation in managing CNMP, which results in lack of confidence and reward. The chart review revealed management practice deficiencies in risk assessment and prescription drug misuse monitoring. As a result, the authors have implemented curricular interventions, integrated a pain clinic within the continuity clinic, optimized residency program clinic scheduling, and developed tools for consistency in management practices.

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