No Time for Teaching?
No Time for Teaching?
Purpose Understanding the association between attending physicians' workload and teaching is critical to preserving residents' learning experience. The authors tested the association between attending physicians' self-reported workload and perceptions of time for teaching before and after the 2003 resident duty hours regulations.
Method From 2001 to 2008, the authors surveyed all inpatient general medicine attending physicians at a teaching hospital. To measure workload, they used a conceptual framework to create a composite score from six domains (mental demand, physical demand, temporal demand, effort, performance, frustration). They measured time for teaching using (1) open-ended responses to hours per week spent doing didactic teaching and (2) responses (agree, strongly agree) to the statement "I had enough time for teaching." They conducted multivariate logistic regression analyses, controlling for month, year, and clustering by attending physicians, to test the association between workload scores and time for teaching.
Results Of 738 eligible attending physicians, 482 (65%) completed surveys. Respondents spent a median of three hours per week dedicated to teaching. Less than half (198; 43%) reporting enough time for teaching. The composite workload scores were normally distributed (median score of 15) and demonstrated a weak positive correlation with actual patient volume (r = 0.25). The odds of an attending physician reporting enough time for teaching declined by 21% for each point increase in composite workload score (odds ratio = 0.79 [95% confidence interval 0.69–0.91]; P = .001).
Conclusions The authors found that attending physicians' greater self-perceived workload was associated with decreased time for teaching.
First in 2003 then again in 2011, the Accreditation Council for Graduate Medical Education reduced the number of working hours for resident physicians. Although studies have demonstrated little change in patient outcomes after these shifts in duty hours regulations, concerns remain regarding the unintended consequences of these restrictions related to resident education and clinical experiences.
One such unintended consequence of shorter resident duty hours that has received little attention is faculty workload. Given that resident physicians are less available, inpatient attending physicians may face increasing workloads with greater responsibility of patient care, which could in turn decrease their time for teaching. Although research on attending physicians' workload and teaching is limited, previous outpatient studies demonstrated that attending physicians' self-perceptions of workload are associated with increased fatigue and decreased satisfaction. An emergency department study demonstrated that attending physicians' ability to provide comprehensive care decreased with an increased workload.
Although data on attending physicians are limited, several studies confirm a negative association between increased resident physicians' workload, measured by patient census, and educational and patient care outcomes. One study reported an increase in patient mortality with more on-call admissions to a resident service. Another study demonstrated that resident physicians perceived that less learning had occurred as patient volume increased.
Understanding the association between inpatient attending physicians' workload and teaching is critical to preserving the learning experience in residency training. With this study, we aimed to test the association between inpatient attending physicians' self-reported workload and their perceptions of time for teaching before and after the 2003 resident duty hours regulations and to explore this relationship at different points in the academic year.
Abstract and Introduction
Abstract
Purpose Understanding the association between attending physicians' workload and teaching is critical to preserving residents' learning experience. The authors tested the association between attending physicians' self-reported workload and perceptions of time for teaching before and after the 2003 resident duty hours regulations.
Method From 2001 to 2008, the authors surveyed all inpatient general medicine attending physicians at a teaching hospital. To measure workload, they used a conceptual framework to create a composite score from six domains (mental demand, physical demand, temporal demand, effort, performance, frustration). They measured time for teaching using (1) open-ended responses to hours per week spent doing didactic teaching and (2) responses (agree, strongly agree) to the statement "I had enough time for teaching." They conducted multivariate logistic regression analyses, controlling for month, year, and clustering by attending physicians, to test the association between workload scores and time for teaching.
Results Of 738 eligible attending physicians, 482 (65%) completed surveys. Respondents spent a median of three hours per week dedicated to teaching. Less than half (198; 43%) reporting enough time for teaching. The composite workload scores were normally distributed (median score of 15) and demonstrated a weak positive correlation with actual patient volume (r = 0.25). The odds of an attending physician reporting enough time for teaching declined by 21% for each point increase in composite workload score (odds ratio = 0.79 [95% confidence interval 0.69–0.91]; P = .001).
Conclusions The authors found that attending physicians' greater self-perceived workload was associated with decreased time for teaching.
Introduction
First in 2003 then again in 2011, the Accreditation Council for Graduate Medical Education reduced the number of working hours for resident physicians. Although studies have demonstrated little change in patient outcomes after these shifts in duty hours regulations, concerns remain regarding the unintended consequences of these restrictions related to resident education and clinical experiences.
One such unintended consequence of shorter resident duty hours that has received little attention is faculty workload. Given that resident physicians are less available, inpatient attending physicians may face increasing workloads with greater responsibility of patient care, which could in turn decrease their time for teaching. Although research on attending physicians' workload and teaching is limited, previous outpatient studies demonstrated that attending physicians' self-perceptions of workload are associated with increased fatigue and decreased satisfaction. An emergency department study demonstrated that attending physicians' ability to provide comprehensive care decreased with an increased workload.
Although data on attending physicians are limited, several studies confirm a negative association between increased resident physicians' workload, measured by patient census, and educational and patient care outcomes. One study reported an increase in patient mortality with more on-call admissions to a resident service. Another study demonstrated that resident physicians perceived that less learning had occurred as patient volume increased.
Understanding the association between inpatient attending physicians' workload and teaching is critical to preserving the learning experience in residency training. With this study, we aimed to test the association between inpatient attending physicians' self-reported workload and their perceptions of time for teaching before and after the 2003 resident duty hours regulations and to explore this relationship at different points in the academic year.
