Healthcare behaviours associated with stress in trainee doctors: a real-time investigation of ward rounds

Abstract

Background: More than a quarter of doctors report experiencing significant stress. Interview studies with trainee doctors commonly report workload, interruptions and time pressure as particularly stress-inducing. These stressors are thought to occur frequently during wards-rounds (daily visits paid by hospital medical teams to each of the patients under their care). This study aimed to investigate trainee doctors’ ward-round behaviour in real-time to establish if there is evidence of putative stress-related situational factors during this work period. Methods: 38 trainee doctors (19 medical, 19 surgical) were observed individually over two ward-rounds at a large UK teaching hospital. Work activity, multitasking and interruptions were recorded continuously using the Work Observation Method by Activity Timing, an Android app for classifying clinical activity. Results: Mean ward-round duration was 106 minutes (SD=44). The frequency of interruptions varied considerably (median=2 interruptions, range=12). Time spent multitasking ranged from 0-44% of the ward-round (median=16%). Periods of inactivity (“waiting†or “on a breakâ€) were virtually non-existent, taking up <1% of all ward-rounds. Discussion: The ward-round is a substantial and relentless period of a trainee doctor’s day, as evidenced by the lack of time spent “off-taskâ€. Stress-related situational factors such as interruptions and multitasking occur to varying degrees, and may be indicative of error-provoking conditions, high workload and time pressure. As much of the work trainee doctors carry out throughout a typical shift is shaped by jobs generated during this work period, ward-rounds are likely to provide the setting conditions for stress and may be an appropriate point for intervention.