scholarly journals Time-motion studies of internal medicine residents' duty hours: a systematic review and meta-analysis

2015 ◽  
pp. 621
Author(s):  
Allen Huang ◽  
Cameron Leafloor ◽  
Heather Lochnan ◽  
Catherine Code ◽  
Erin Keely ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Systematic Review ◽  
Meta Analysis ◽  
Duty Hours ◽  
Time Motion ◽  
Internal Medicine Residents ◽  
Motion Studies

scholarly journals Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021711 ◽  
Author(s):  
Judy A Shea ◽  
Jeffrey H Silber ◽  
Sanjay V Desai ◽  
David F Dinges ◽  
Lisa M Bellini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Medicare Beneficiaries ◽  
Internal Medicine Training ◽  
Duty Hours ◽  
Time Motion ◽  
Wrist Actigraphy ◽  
Resident Duty

IntroductionMedical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness.Methods and analysis63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses.Ethics and disseminationThe University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process.Trial registration numberNCT02274818; Pre-results.

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

BMJ Open ◽  
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.

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

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. 

scholarly journals Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations

2019 ◽  
Vol 179 (6) ◽  
pp. 760 ◽  
Author(s):  
Krisda H. Chaiyachati ◽  
Judy A. Shea ◽  
David A. Asch ◽  
Manqing Liu ◽  
Lisa M. Bellini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
First Year ◽  
Time Motion ◽  
Internal Medicine Residents

scholarly journals Medical Procedure Services in Internal Medicine Residencies in the US: a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Muhammad H. Hayat ◽  
Matthew H. Meyers ◽  
Ioannis A. Ziogas ◽  
Majd A. El-Harasis ◽  
Lawrence T. Heller ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Systematic Review ◽  
Meta Analysis ◽  
Medical Procedure ◽  
The Us ◽  
Internal Medicine Residencies

scholarly journals Training and Performance Differences in US Internal Medicine Residents Trained in Community- and University-Based Programs – a Systematic Review

2018 ◽  
Vol 7 (2) ◽  
pp. 98
Author(s):  
Yasir Rehman
Keyword(s):  
Internal Medicine ◽  
Meta Analysis ◽  
Pass Rate ◽  
Cross Sectional ◽  
Publication Rates ◽  
Performance Differences ◽  
Internal Medicine Residents ◽  
The Difference ◽  
And Performance ◽  
Review Reports

Introduction:Residents’ learning and performance depends on program structures, clinical setting and faculty mentors; however,performance differences between and community based vs. university based residents have not been exploredsystematically.Objectives:To systematically review the performance differences between internal medicine residents trained in community-basedprograms [CBPs] versus university-based programs [UBPs] in the US.Methods:Eligible studies were identified in Medline and Embase databases from 1990- June 2018. Eligible studies comparedlearning and performance differences between UBP and CBP internal medicine residency programs aligned withACGME recommendations.Results:Out of 4916 titles, 14 cross-sectional studies were included in the analysis. Diverse reporting among the includedstudies precluded meta-analysis. Significant differences were found in specific practice areas, such as knowledge aboutHIV, nutrition training, and program accreditation cycle. Residents in UBPs participated more often in hypothesisdriven research and had higher publication rates than residents in CBPs. Residents trained in CBPs experienced moreburnt out than those in UBPs and had higher prevalence of residents with problematic behaviors and deficiencies.Nonsignificant differences were found among residents regarding ABIM pass rate, medical procedures, and publichealth training.Conclusion:Our review reports inconsistent trends in residents’ learning and performances following RRC- IM and ACGMErecommendations. Significant differences were noted in areas that required more practice and system based learning,non-procedural skills and patient care. Future studies with larger sample sizes and adjusted analyses are needed toevaluate the difference between residents’ performance and learning in UBPs versus CBPs.

scholarly journals The Impact of Duty Hours Restrictions on Job Burnout in Internal Medicine Residents

2015 ◽  
Vol 90 (4) ◽  
pp. 494-499 ◽  
Author(s):  
Jonathan A. Ripp ◽  
Lisa Bellini ◽  
Robert Fallar ◽  
Hasan Bazari ◽  
Joel T. Katz ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Job Burnout ◽  
Duty Hours ◽  
Internal Medicine Residents ◽  
The Impact

scholarly journals A Reduced Duty Hours Model for Senior Internal Medicine Residents

2016 ◽  
Vol 91 (9) ◽  
pp. 1284-1292 ◽  
Author(s):  
Rebecca Mathew ◽  
Serena Gundy ◽  
Diana Ulic ◽  
Shariq Haider ◽  
Parveen Wasi
Keyword(s):  
Internal Medicine ◽  
Duty Hours ◽  
Internal Medicine Residents

Baseline duty hours recorded with time-cards: a pre-regulation study of internal medicine residents

2006 ◽  
Vol 40 (7) ◽  
pp. 662-666 ◽  
Author(s):  
Larry W Chang ◽  
Arpana R Vidyarthi ◽  
R Jeffrey Kohlwes
Keyword(s):  
Internal Medicine ◽  
Duty Hours ◽  
Internal Medicine Residents

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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