Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool

BMJ Open. 2020 Feb 16;10(2):e033021. doi: 10.1136/bmjopen-2019-033021.


Objectives: The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings.

Design: Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer).

Setting: Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital.

Participants: 28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital.

Outcomes: Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals.

Results: Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively.

Conclusions: We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

Keywords: health economics; internal medicine; medical education & training.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Benchmarking / methods*
  • Female
  • Hospitals, Community
  • Hospitals, University
  • Humans
  • Internal Medicine / education*
  • Internship and Residency / statistics & numerical data*
  • Male
  • Patient Care / statistics & numerical data*
  • Time and Motion Studies*