Magnusson A R, Hedges J R, Harper R J, Greaves P
Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201, USA.
Acad Emerg Med. 1999 Sep;6(9):939-46. doi: 10.1111/j.1553-2712.1999.tb01245.x.
To compare in-hospital time uses by first-postgraduate-year (PGY1) residents during rotations in emergency medicine (EM), internal medicine (IM), and surgery (S). This article reports the clinical components of residency time use.
A cross-sectional, observational study of the clinical activities of EM PGY1 residents was performed while the residents were on duty during the three specialty rotations. The activities were recorded by an observer using a log with predetermined categories for clinical activities. A time-blocked, convenience sample of resident shifts was observed for each service rotation. The sample was proportional to the total number of hours for which a PGY1 resident was expected to be in the hospital during a rotation on that service. No attempt was made to sample the same resident at all time periods or on all rotations. Proportions were compared by chi2; alpha = 0.0001.
Twelve PGY1 residents were observed for a total of 166 hours on S, 156 hours on IM, and 120 hours on EM. These hourly amounts were representative of a typical two-week span of service on each rotation for the residents. On average, the residents spent 57% of their time on clinical or service-oriented activities. During EM and IM rotations, the residents spent most of their time performing clinical information gathering and engaging in case management and data synthesis (52% of total clinical effort). Within this category, residents on EM were more involved with case discussion and review of ancillary test results than on IM (34% vs 20% of time in this category). Conversely, proportionately less time in this category was devoted to documentation on the EM vs IM rotation (56% vs 80%; p < 0.0001). The greatest opportunity to perform procedures was on the S rotation (31% of total clinical time vs 6% for other specialties; p < 0.0001).
Awareness of the clinical activities performed on PGY1 rotations can help residency directors anticipate educational needs to balance their residents' experience. Since 29% and 42% of total clinical time on PGY1 EM and IM rotations, respectively, is focused on documentation, efforts to enhance charting skills and efficiency are warranted. Also, efforts to enhance PGY1 procedural experience outside of the S rotation appear warranted.
比较一年级住院医师（PGY1）在急诊科（EM）、内科（IM）和外科（S）轮转期间的住院时间使用情况。本文报告住院医师时间使用的临床组成部分。
对EM PGY1住院医师在三个专科轮转值班期间的临床活动进行横断面观察研究。观察者使用带有预定临床活动类别的日志记录活动。对每个服务轮转进行按时间段划分的、方便抽样的住院医师班次观察。该样本与PGY1住院医师在该服务轮转期间预计在医院的总小时数成比例。未尝试在所有时间段或所有轮转中对同一名住院医师进行抽样。比例通过卡方检验进行比较；α = 0.0001。
观察了12名PGY1住院医师，在S轮转上共观察166小时，在IM轮转上共观察156小时，在EM轮转上共观察120小时。这些每小时的时长代表了住院医师在每个轮转上典型的两周服务时长。平均而言，住院医师将57%的时间用于临床或服务导向活动。在EM和IM轮转期间，住院医师大部分时间用于进行临床信息收集以及参与病例管理和数据综合（占总临床工作的52%）。在此类别中，EM住院医师比IM住院医师更多地参与病例讨论和辅助检查结果审查（该类别中分别占34%和20%的时间）。相反，在该类别中，EM轮转用于记录的时间比例比IM轮转少（56%对80%；p < 0.0001）。进行操作的最大机会在S轮转上（占总临床时间的31%，其他专科为6%；p < 0.0001）。
了解PGY1轮转期间进行的临床活动有助于住院医师培训主任预测教育需求，以平衡住院医师的经验。由于PGY1在EM和IM轮转期间分别有29%和42%的总临床时间用于记录，因此有必要努力提高病历书写技能和效率。此外，似乎有必要努力在S轮转之外增加PGY1的操作经验。
