Doing the Dirty Work: Measuring and Optimizing Resident Workload

Abstract

The importance of patient care in the development of future physicians has been recognized since well before Osler’s time. Indeed, patient care experiences are the cornerstone of undergraduate and graduate medical education. While the purpose of residency training is to cultivate competent physicians primarily through direct patient care experiences, the optimal level of clinical work necessary to ensure resident learning and quality of care has not been well defined. In this issue of the Journal of General Internal Medicine, Coit and colleagues consider whether reducing resident workload improves quality of patient care. 1 The investigators implemented an experimental inpatient medicine rotation to reduce residents’ workload at a community hospital. The intervention teams were comprised of three interns and two upper level residents, and the control teams consisted of two interns and one upper level resident. In addition, the intervention teams took call every sixth night and were limited to five admissions per resident, while the control teams were on call every fourth night and could admit up to twelve patients. Both teams were in compliance with ACGME duty hour standards. The outcome of interest in this study was the quality of residents’ discharge summaries, as measured by an instrument based on Joint Commission standards. The investigators demonstrated significant improvement in the quality of discharge summaries prepared by the intervention teams compared to those prepared by the control teams. Of note, certain aspects of discharge summaries were inadequately completed by residents in both groups, highlighting the need for further innovations to enhance the quality of discharge