All in A Day's Work Doctors in Hospital Wards and Doctors-in-training

In the research article, Professor Johanna Westbrook and her co-authors from the University of Sydney's Health Infomatics Research and Evaluation Unit, carried out a study to find out how much time doctors in hospital wards spend on specific work tasks, with health professionals and patients.

Professor Westbrook said her team observed 19 doctors (seven registrars, five residents and seven interns) in four wards at a teaching hospital in Sydney between July and December 2006.

"What we found was that doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units," she said. "On average doctors spent 15% of their time with patients."

"The results also confirmed what interns have been saying for a long time - they are dissatisfied with their level of administrative work and documentation."

Professor Westbrook said this study provided a basis for comparing changes in doctors' patterns of time distribution after the introduction of interventions such as computerised medical record systems.

"While such systems are promoted as reducing administrative tasks of clinicians, concerns were raised that many tasks, such as ordering medication and tests, may have actually been quicker with the paper-based systems," she said. "Just as required for other interventions in the health system, we need good evidence as to whether these systems support health professionals to make work more efficient and safer. Using these results we will be able to measure whether this is the case."

In one of the editorials of the latest edition of The Medical Journal of Australia, Professor Mark Brown and his co-author, Stephanie Arnold, from the NSW Institute of Medical Education and Training, examine whether the time-honoured 'apprenticeship' model of doctors-in-training still works.

Professor Brown said that if consultants wanted the privilege of doctors-in-training on the team, then they needed to support them and help structure their days towards learning.

"Is it too much to ask that doctors-in-training are taught a variety of skills while caring for patients, without the burden of unnecessary tasks, and with meaningful feedback and supervision, and time for reflection and self-care?" he said.

"There is a push for doctors-in-training to be allocated to a ward rather than to a traditional medical team, but the risk for this is that many doctors-in-training may lose the supervision they require.

"On the other hand, it is clear that supervision and feedback is not always given in the present system," he said.

Professor Brown said that we need to begin training in more meaningful places, such as the private sector, general practices, and other community settings to provide proper feedback, supervision and caring for our next generation of doctors.

"There has been progress but we can do better," he said.

The Medical Journal of Australia is a publication of the Australian Medical Association.