Liu CC, Wissow L. How post-call resident doctors perform, feel and are perceived in out-patient clinics. Med Educ. 2011 Jul;45(7):669-77.
(Resident Training, United States)
CONTEXT: Recently, in the USA, the Accreditation Council for Graduate Medical Education guidelines limited residents' consecutive duty to 24 hours. In Europe, the European Working Time Directive limits the average working week to 48 hours. OBJECTIVES: This study aimed to examine the performance of post-call residents in out-patient interviews using subjective and objective measures and to assess residents' subjective feelings. METHODS: We conducted a cross-sectional analysis of a systematic sample of 170 paediatric primary care consultations conducted during 117 clinic sessions served by 47 residents at a teaching hospital, including 34 consultations conducted during 23 sessions by 20 post-call residents. Interviews were audiotaped and quantitatively analysed using the Roter Interactional Analysis System (RIAS). Residents and patients' parents gave subjective appraisals of the visits using short questionnaires. Major covariates are resident gender and the timing of the clinic. RESULTS: Results did not show significant differences between post-call residents and their peers who had left the hospital on time in most components of the out-patient interview. Subtle yet probably important differences emerged with findings that post-call residents were significantly less likely to ask a parent to repeat what she had just said, and parents seeing post-call residents were more likely to request the resident to repeat what he or she had just said and to check if the resident understood what they had said. Post-call residents were rated by objective coders as having better attitudes than their left-on-time counterparts, yet subjectively felt less satisfied and more fatigued. Female post-call residents felt less competent, less productive and less energetic; male post-call residents felt more challenged, more demoralised and busier. CONCLUSIONS: The changes in activating and partnering talk that occur in post-call residents are consistent with findings concerning sleep deprivation and speech. Female and male residents tended to attribute their post-call performance to different factors. Setting limits on working hours might help to avoid potential negative impacts on post-call resident feelings, and the impact of working hours on resident performance warrants further exploration.
Liu CC, Wissow LS. Residents who stay late at hospital and how they perform the follow day. Med Educ. 2008 Jan; 42 (1): 74-81.
(Pediatric Residents, Taiwan)
Context The limits imposed on the official working hours of paediatric residents do not necessarily reduce the amount of time they spend at work. Fatigue and stress can result from staying late voluntarily, and this in turn can alter clinical performance, much as long obligatory hours did in the past. Methods A cross-sectional analysis was made of a systematic sample of 243 primary care visits conducted in 1990 by 52 paediatric residents at a teaching hospital. The paediatric residents reported on their work responsibilities the night before each primary care visit and their communication style during the visit was analysed from recordings made on audiotapes using the Roter Interactional Analysis System (RIAS). Results Paediatric residents who care for critically ill children were more likely to stay late even if they were not on call. During primary care visits the next day, those paediatric residents who stayed late were more verbally dominant - their verbal input, as a proportion of the total, was: 0.67 (stayed late) versus 0.62 (on call), P = 0.007; 0.67 (stayed late) versus 0.64 (left on time), P = 0.02. Paediatric residents who stayed late displayed less patient-centredness: patient-centred talk as a proportion of total 0.31 (stayed late) versus 0.36 (on call), P = 0.02; 0.31(stayed late) versus 0.34 (left on time), P = 0.03. Compared with paediatric residents who left on time, those who stayed late reported feeling less fulfilled; if their clinic was in the afternoon, they also reported more fatigue. Conclusions The care of critically ill children may make paediatric residents more liable to remain at work after the end of their shift. The clinical interactions of such residents were more dominant and less patient-centred. Helping paediatric residents to learn to manage their work while under clinical stress could promote better adherence to guidelines on working hours and have a positive impact on patient care.
Pahal JS, Li HZ. The dynamics of resident-patient communication: data from Canada. Commun Med. 2006;3(2):161-70.
(Resident Training, Canada)
The objectives of this study were to examine patterns of resident-patient communication and the relationship between resident patterns of speech with patient satisfaction. Forty consultations, ten in each of the four gender combinations (male resident/male patient, male resident/female patient, female resident/female patient, female resident/male patient) were audiotaped and microanalyzed using the Roter Interaction Analysis System. Several findings depart significantly from previous studies with physician-only or physician-resident-mixed samples. First, the average length of the 40 consultations was 19.5 minutes, 11.3 minutes longer than consultations in a physician-only sample drawn in the same clinic previously. Second, male residents engaged in twice as much psychosocial talk as female residents and conducted longer consultations. Third, residents asked 80% of the total questions while patients asked 20% of the questions. Previous studies with physician-only or physician-resident-mixed samples reported that physicians ask 89-99% of the total questions. Finally, patients' overall satisfaction and communication satisfaction were negatively correlated with residents' positive talk, which constitutes 31% of a given resident's total utterances. In the study conducted in the same clinic with a physician-only sample, physician positive talk was 26% and physician positive talk was not correlated with patient satisfaction. Is this a signal that residents should reduce the amount of positive talk? Apparently more studies with resident-only samples are needed to answer this and other unanswered questions in the field to offer directives to resident training.
Resources by Subject Area
Following are abstracts of RIAS studies through 2012, listed by subject area. Click on the subject name below to go directly to that section.
Bad News Delivery
Outside Primary Care