Does doctors' workload impact supervision and ward activities of final-year students? A prospective study

Abstract

Background: Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students.

Methods: A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities--both medical and non-medical--according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question.

Results: A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ± 1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown.

Conclusions: There was a significant association between ward doctors' supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

Figure 1

Formula of the workload-index. Formula for the daily workload index: n = total number of patients on the corresponding ward; CF_PPCL = correction factor according to the patient comorbidity complexity level (PCCL) in the national reimbursement system, _CFAd/Dis = correction factor according to whether the respective patient was admitted or discharged on the day in question; n_Doc = number of residents on that ward that day.

Figure 2

Activities performed by the students per day. Activities per day that the students reported to have actively performed, either with or without supervision. Gray: non-medical activities, black: medical activities. White: physical examination and history taking.

Figure 3

Medical activities on day 1–8. Trajectories of number of medical activities performed according to workload over Days 1 to 8.