Internal medicine trainees' views of training adequacy and duty hours restrictions in 2009

Abstract

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.