Allocation of Internai Medicine Resident Time in a Swiss Hospital: A Time and Motion Study , the Médical Day (MeDay) Study

Background: Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. Objective: To describe how residents allocate their time during day and evening hospital shifts. Design: Time and motion study. Setting: Internal medicine residency at a university hospital in Switzerland, May to July 2015. Participants: 36 internal medicine residents with an average of 29 months of postgraduate training. Measurements: Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Results: Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. Limitation: The study involved a small sample from 1 institution. Conclusion: At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Primary Funding Source: Information Technology Depart- ment and Department of Internal Medicine of Lausanne University Hospital