Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations.

Full 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.

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Author information

Author/s: Harrison, Rebecca (R); Allen, Elizabeth (E);

Affiliation: Division of Hospitalist Medicine, Oregon Health & Science University, Portland, OR 97239, USA. harrisor(-atsign-)ohsu.edu

Journal and publication information

Publication Type: Journal Article

Journal: Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine (J Gen Intern Med), published in United States. (Language: eng)

Reference: 2006-May; vol 21 (issue 5) : pp 447-52

Dates: Created 2006/05/17; Completed 2006/08/29; Revised 2008/11/20;

PMID: 16704386, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attitude of Health Personnel
Female
Focus Groups
Humans
Internal Medicine - education; standards
Internship and Residency - standards

Male
Medical Staff, Hospital - psychology
Oregon
Teaching - methods; standards
Work Schedule Tolerance
Workload - standards

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