Work Patterns and Intensity of Chinese Surgical Residents- A Multicenter Time-and-Motion Study

Yong Liu; TJie Tan; James Reeves Mbori Ngwayi; Xiaolin Zhuang; Zhaohan Ding; Yujie Chen; Yufa Zhou; Daniel Edward Porter

doi:10.1016/j.jsurg.2023.09.005

Work Patterns and Intensity of Chinese Surgical Residents- A Multicenter Time-and-Motion Study

J Surg Educ. 2024 Jan;81(1):76-83. doi: 10.1016/j.jsurg.2023.09.005. Epub 2023 Oct 17.

Authors

Yong Liu¹, TJie Tan², James Reeves Mbori Ngwayi³, Xiaolin Zhuang⁴, Zhaohan Ding⁵, Yujie Chen⁶, Yufa Zhou⁷, Daniel Edward Porter⁸

Affiliations

¹ The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China.
² Beijing Jishuitan Hospital, Trauma Department, Beijing Jishuitan Hospital, Beijing, China. Electronic address: tanjie@bjmu.edu.cn.
³ Department of Trauma and Orthopaedics, Princess Alexandra Hospital, Harlow, United Kingdom.
⁴ Department of Trauma, Luohe Central Hospital, Luohe City, Henan Province, China.
⁵ Medical Department, Linyi Cancer Hospital, Linyi City, Shandong Province, China.
⁶ Tongji Hospital, Shanghai, China.
⁷ Department of Anesthesiology, Ningbo Lihuili Hospital, Ningbo city, Zhejiang Province, China.
⁸ Department of Orthopaedics, Beijing Huaxin Hospital, Beijing, China.

PMID: 37852874
DOI: 10.1016/j.jsurg.2023.09.005

Abstract

Objective: This study aimed to record and analyze surgical resident trainee time allocation among junior doctors in China in order to understand the training environment and optimize realistic training and patient care objectives.

Design: Multicenter observational time and motion study.

Setting: Multicenter, carried out in 5 tier 3 public hospitals in 5 provinces across China.

Participants: Surgical resident trainees at various stages of training were eligible to enter the study, total n = 44. Registered nurses were eligible to be observers, n = 4 from each hospital. An expert team comprising 4 chief surgeons and 10 surgical residents participated in establishing the clinical activity list.

Results: Participants were observed during working hours (08.00-17.00) for 10 consecutive working days and time spent on different activities were recorded. Work patterns between hospitals were often dissimilar. Most time was spent on direct patient care (34.1%; 95% CI, 28.0%-40.1%) followed by indirect patient care (24.4%; 95% CI, 15.5%-33.2%), scholarly activity (21.1%; 95% CI, 13.7%-28.5%) and other (20.4%; 95% CI, 14.1%-26.8%). Subcategory analysis showed that the amount of time spent each day performing certain tasks was 137 minutes for operating theatre tasks, 103 minutes for medical record-keeping, 25 minutes for direct patient contact, 20 minutes being taught, 12 minutes teaching others, 12 minutes hand-over time, and 0 minutes of outpatient clinic attendance. Inter-observer reliability of 96.5% was obtained prior to recordings.

Conclusions: Chinese surgical resident work patterns fall within the range found in other international studies albeit with some exceptions. The training environment appears broadly suitable for competence-based surgical training in China. Inadequate outpatient activity has led to changes in trainee work rosters and trainer requirements. Both strengths and deficiencies were confirmed and addressed. Further audit is required.

Keywords: multicenter; patient care; surgical residents; time-motion study; workflow.

Publication types

Multicenter Study

MeSH terms

Hospitals
Humans
Internship and Residency*
Operating Rooms
Reproducibility of Results
Time and Motion Studies