Teaching Internal Medicine Residents in the New Era
Inpatient Attending with Duty-Hour Regulations
Article first published online: 2 MAY 2006
Journal of General Internal Medicine
Volume 21, Issue 5, pages 447–452, May 2006
How to Cite
Harrison, R. and Allen, E. (2006), Teaching Internal Medicine Residents in the New Era. Journal of General Internal Medicine, 21: 447–452. doi: 10.1111/j.1525-1497.2006.00425.x
- Issue published online: 2 MAY 2006
- Article first published online: 2 MAY 2006
- resident education;
- inpatient teaching;
- duty hours
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.