• Nathalie Wenger, Marie Méan, Julien Castioni, Pedro Marques-Vidal, Gérard Waeber, and Antoine Garnier.
• From Lausanne University Hospital, Lausanne, Switzerland.
• Ann. Intern. Med. 2017 Apr 18; 166 (8): 579-586.

BackgroundLittle current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers.ObjectiveTo describe how residents allocate their time during day and evening hospital shifts.DesignTime and motion study.SettingInternal medicine residency at a university hospital in Switzerland, May to July 2015.Participants36 internal medicine residents with an average of 29 months of postgraduate training.MeasurementsTrained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded.ResultsResidents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m.LimitationThe study involved a small sample from 1 institution.ConclusionAt this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer.Primary Funding SourceInformation Technology Department and Department of Internal Medicine of Lausanne University Hospital.

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