How residents spend their nights on call

Purpose. Night call is a significant part of residents' education, but litt le information about their night-call activities is available. This study r ecorded residents' activities during night-call rotations on internal medic ine and pediatrics wards. Method. In June and July 1997, on-call pediatrics and internal medicine res idents at an urban academic medical center were accompanied by trained obse rvers on the general wards between the hours of 7 PM and 7 AM. The types an d duration of activities were recorded. Results. Residents were observed for 106 nights. Internal medicine and pedi atrics residents spent their time similarly. They spent 5.3 hours and 5.7 h ours per night, respectively, on "basic" activities such as eating, resting , chatting, and sleeping, and an average of 2.6 hours and 2.2 hours, respec tively, on chart review and documentation. In both programs, discussing the case with team members averaged 1.5 hours per night and use of the compute r averaged slightly more than half an hour. Internal medicine residents spe nt approximately 1.5 hours on patients' history and physical examinations w hile pediatrics residents spent 1.3 hours. With each new patient, internal medicine residents spent an average of 19.7 minutes and pediatrics resident s spent 16.5 minutes. The only significant difference between the two group s of residents was that the pediatrics residents spent more time per night on procedures than did the internal medicine residents (37 minutes versus 1 4 minutes, p < 0.01). Conclusions. Residents from both programs spent a surprising amount of time each night on chart review and documentation. In fact, they spent more tim e with charts than with patients. Whether this activity truly contributes t o residents' education or improved patients' outcomes is not clear.