Abstract
BACKGROUND: Little is known about the impact of resident duty-hour regulations on the inpatient teaching experience.
OBJECTIVE: Provide descriptive information on the effect of resident duty-hour regulations on attendings and the educational environment.
DESIGN: Qualitative analysis of attending focus groups and e-mail survey of residents in Internal Medicine.
PARTICIPANTS: Inpatient attending physicians at 2 academic centers and residents at the affiliated university-based Internal Medicine residency program in Portland, OR.
RESULTS: Seventy-two percent of eligible attendings participated in 2 focus groups. Three themes were generated: increased clinical role, altered time management, and altered teaching. Attending physicians report performing more clinical work, teaching less, using more focused teaching methods, and experiencing an increased perception of intensity. Forty percent of eligible residents completed our e-mail survey. We organized residents data using the same 3 themes as attending physician data. Residents observed attending physicians performing increased clinical work, being more time aware, delivering more focused teaching, and having less time to teach. Participants noted changes in autonomy and professionalism. Strategies to enhance teaching effectiveness in the new environment were described.
CONCLUSION: Duty-hour regulations have increased attending clinical responsibility and decreased teaching time in 1 residency program, leading to the perception of a more intense attending experience. Duty-hour regulations encourage educators to determine what is critical to preserve in the educational experiences of learners and challenge us to reexamine autonomy and professionalism in training.
Similar content being viewed by others
References
Institute for the Future. Health and Healthcare 2010: The Forecast, the Challenge. San Fransisco: Jossey-Bass; 2003.
Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–48.
Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351:1829–37.
Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005;352:125–34.
Buysse DJ, Barzansky B, Dinges D, et al. Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care. Sleep. 2003;26:218–25.
Samkoff JS, Jacques CH. A review of studies concerning effects of sleep deprivation and fatigue on residents’ performance. Acad Med. 1991;66:687–93.
Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA. 2002;288:1112–4.
Wallack MK, Chao L. Resident work hours: the evolution of a revolution. Arch Surg. 2001;136:1426–31; discussion 1432.
American Medical Association Question of the Month. Duty hour regulations: what is your experience? September 2003. Available at: http://www.ama-assn.org/ama/pub/category/11566.html. Accessed January 1, 2006.
Schroeder SA. How many hours is enough? An old profession meets a new generation. Ann Intern Med. 2004;140:838–9.
Charap M. Reducing resident work hours: unproven assumptions and unforeseen outcomes. Ann Intern Med. 2004;140:814–5.
Skeff KM, Ezeji-Okoye S, Pompei P, Rockson S. Benefits of resident work hours regulation. Ann Intern Med. 2004;140:816–7.
Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.
Kogan JR, Bellini LM, Shea JA. The impact of resident duty hour reform in a medicine core clerkship. Acad Med. 2004;79(suppl):S58-S61.
Ferenchick G, Simpson D, Blackman J, DaRosa D, Dunnington G. Strategies for efficient and effective teaching in the ambulatory care setting. Acad Med. 1997;72:277–80.
Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Acad Med. 2004;79:42–9.
Bowen JL, Alguire P, Tran LK, et al. Meeting the challenges of teaching in ambulatory settings: a national, collaborative approach for internal medicine. Am J Med. 1999;107:193–7.
DaRosa DA, Dunnington GL, Stearns J, Ferenchick G, Bowen JL, Simpson DE. Ambulatory teaching “lite”: less clinic time, more educationally fulfilling. Acad Med. 1997;72:358–61.
Wilson MC. In pursuit of optimal duty hours and resident experiences. J Gen Intern Med. 2004;19:97–8.
Phy MP, Offord KP, Manning DM, Bundrick JB, Huddleston JM. Increased faculty presence on inpatient teaching services. Mayo Clin Proc. 2004;79:332–6.
Newton DA, Grayson MS, Thompson LF. The variable influence of life-style and income on medical students’ career specialty choices: data from two U.S. medical schools, 1998–2004. Acad Med. 2005;80:809–14.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harrison, R., Allen, E. Teaching internal medicine residents in the new era. J GEN INTERN MED 21, 447–452 (2006). https://doi.org/10.1111/j.1525-1497.2006.00425.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2006.00425.x