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Internal Medicine Trainees’ Views of Training Adequacy and Duty Hours Restrictions in 2009

Shea, Judy A. PhD; Weissman, Arlene PhD; McKinney, Sean; Silber, Jeffrey H. MD, PhD; Volpp, Kevin G. MD, PhD

doi: 10.1097/ACM.0b013e3182582583
Graduate Medical Education

Purpose: To gauge internal medicine (IM) trainees’ perceptions regarding aspects of their inpatient rotations, including supervision, educational opportunities, the perceived effect of duty hours regulations on quality of patient care, the causes of medical errors, and sleep.

Method: The authors analyzed the results of questionnaires administered to trainees following the October 2009 in-training examinations (ITE).

Results: Of the 21,768 IM trainees in postgraduate years 1 through 3 who took the IM-ITE, 18,272 (83.9%) responded. The majority of these trainees (87.7%) reported that supervision was adequate, and nearly half (46.3%) reported insufficient or minimal time to participate in learning activities. Two-thirds or more thought that specific work regulations such as limited shift length and more time off after nights and extended shifts would at least “occasionally,” if not “usually” or “always,” improve patient care. IM trainees at least “occasionally” attributed errors to workload (68.8% of respondents), fatigue (66.9%), inexperience or lack of knowledge (61.0%), incomplete handoffs (60.2%), and insufficient ancillary staff (53.5%). IM trainees’ sleep hours were limited during extended and overnight shifts.

Conclusions: IM trainees agree that limited educational opportunities are the weakest part of the average inpatient rotation. Few have complaints about the adequacy of supervision. These trainees’ optimism regarding the positive influence of potential work hours restrictions on patient care and their views of likely causes of medical errors suggest the need for innovative patient care schedules and education curricula.

Dr. Shea is professor of medicine–clinician educator and associate dean of medical education research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Weissman is director, Research Center, American College of Physicians, Philadelphia, Pennsylvania.

Mr. McKinney is director, Self-Assessment Programs, American College of Physicians, Philadelphia, Pennsylvania.

Dr. Silber is professor of pediatrics and of anesthesiology and critical care, Perelman School of Medicine, University of Pennsylvania, and professor of health care management, Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Volpp is staff physician, Center for Health Equity Research and Promotion (CHERP), Philadelphia Veterans Affairs Medical Center, and professor, Perelman School of Medicine and Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania.

Correspondence should be addressed to Dr. Shea, Perelman School of Medicine at the University of Pennsylvania, 1223 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104-6021; telephone: (215) 573-5111; fax: (215) 573-8778; e-mail: sheaja@mail.med.upenn.edu.

© 2012 Association of American Medical Colleges