How post‐call resident doctors perform, feel and are perceived in out‐patient clinics

Medical Education 2011: 45 : 669–677 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.