Abstract
BackgroundHospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students.MethodsA total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question.ResultsA total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown.ConclusionsThere was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.
Highlights
Some medical activities with a higher degree of complexity are rarely taught in separate classes; it is generally assumed that such skills are acquired during internships, which in most curricula become completed during the final year of medical education [7]
In order to increase supervision, reducing the workload arising from patient care alone might not be sufficient, and additional factors as e.g. the individual learner-supervisor-relationship or structured feedback training may be necessary [9]
In addition we investigated only the workload arising purely from patient care calculated from the electronic hospital information system
Summary
An aging population and increasing economical restraints have led to considerable efforts to optimize health care systems across the world [1,2]. For most doctors, these changes have entailed having to care for more patients with more comorbidities in a shorter space of time, resulting in a considerable increase in workload in regard to patient care [3,4]. Studies that focus on the supervision, feedback and assessment of medical students during clerkships generally show that the situation is not optimal. In a study by Howley et al among 345 medical students in the U.S, 51 % of the students reported that they had never been observed during history taking (81 % for a complete physical examination) by faculty staff [13]
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