Internal Medicine Residents' Computer Use in the Inpatient Setting

Background Studies have suggested that patient contact time for internal medicine residents is decreasing and being replaced with computer-related activities, yet objective data regarding computer use by residents are lacking. Objective The aim of this study was to objectively measure time use by internal medicine residents while on duty in the hospital setting using real-time, voice-capture technology. Methods First- and third-year categoric internal medicine residents participated (n = 25) during a 3-month period in 2010 while rotating on general internal medicine rotations. Portable speech-recognition technology was used to record residents' activities. The residents were prompted every 15 minutes from an earpiece and asked to categorize the activity they had been doing since the last prompt, choosing from a predetermined list of 15 activities. Results Of the 1008 duty-time responses, 493 (49%) were classified as computer-related activities, whereas 341 (34%) were classified as direct patient care, 110 (11%) were classified as noncomputer-related education, and 64 (6%) were classified as other activities. Of resident reported computer-use time, 70% was spent on patient notes and order entry. Conclusions The results of our study suggest that computer use is the predominant activity for internal medicine residents while in the inpatient setting. Work redesign because of duty hour regulations should consider how to free up residents' time from computer-based activities to allow residents to engage in more direct patient care and noncomputer-based learning.