So much has been written about the need to reduce work hours for trainees, but doing so has not necessarily reduced fatigue and if anything has increased the need for better hand-offs of care from one resident to the next due to the shorter duration of calls they are allowed to take. But what if the issue were not the need to reduce quantity of hours, but the variation in intensity of work done over those hours to further improve the quality of care delivery by residents to patients?
Was et al. (peds.2015-2836) undertook a study of a database from Stanford involving a download of all electronic notes and orders written by pediatric residents over the 2-year period from 2012-2014 and then compared with residents’ own self-report of the intensity of their workload. The authors opted to study the correlation between note-writing and order-entry workload intensity. To no surprise there was large variability between order writing and note writing workload intensity although there was no correlation between the workload intensity and the resident self-perception of how high that intensity really was.
Rather than focus just on the duration of work hours experienced by a trainee, this study calls for a different spin and a focus on standardizing the intensity of the work so as to perhaps better control the potential for error as well as the overall wellness of the resident –both of which were initially viewed as a result of long work hours. This paper suggests a different hypothesis—one where quality or intensity of work done is more important than number of hours worked. Do you agree? We would love to hear your take on intensity vs quantity of time worked in training by responding to this blog, sending a comment
