COMPARISON OF HOUSESTAFFS ESTIMATES OF THEIR WORKDAY ACTIVITIES WITH RESULTS OF A RANDOM WORK-SAMPLING STUDY

Background. Accurately quantifying housestaff's workday activities is acquiring increasing importance as resources become constrained and pr ograms become more accountable for medical education. The authors comp ared a traditional method of time analysis based on housestaff's estim ates of how they spent their workdays with the results of a formal tim e-analysis study based on random work sampling. Method. All housestaff (18 interns and 18 residents) rotating on a general medicine service at Duke University Medical Center between December 1991 and March 1992 participated in the study. Twenty-six of the housestaff first provide d estimates of how they spent their workdays, and then all 36 wore ran dom reminder beepers and recorded what they were doing (activity) and with whom (contact) at each beep. Results. The housestaff overestimate d the amounts of time spent in patient evaluation (e.g., the mean esti mated proportion of time spent performing histories and physical exami nations was 29%, whereas the mean actual proportion was 17%) and in ed ucational activities (e.g., the mean estimated proportion of reading t ime was 8.4%, whereas the mean actual proportion was 2.7%). The houses taff underestimated the amount of supervision by attending physicians: the mean estimated proportion was 7.7%, whereas the mean actual propo rtion was 16.9%. Conclusion. The Housestaff's estimates of workday tim es differed from the observed times measured by random work sampling. These inaccuracies were manifest in several important areas, such as p atient evaluation, educational activities, and attending physicians' s upervision. These results suggest that program directors who seek to d escribe housestaff's work activities or wish to determine the effects of administrative interventions should use random work sampling as the measure.