Abstract
Background
The educational environment and burnout during Internal Medicine subspecialty fellowship training are important for learning outcomes. Understanding how trainees allocate their time and identifying stressors are important steps to improving the training experience.
Objective
We examined Internal Medicine fellows’ time allocation during training. We also investigated perceptions of work experience on the inpatient consultation services.
Methods
A survey instrument was sent to Internal Medicine subspecialty fellows in consecutive years (2019 and 2020) at a single academic medical center.
Results
116 fellows responded representing ten subspecialty fellowships (32% response rate). The majority of self-reported time was spent on clinical care in the first two years and in research in the third year. Note writing represented approximately one-third of total patient care time. Studying was reported as the activity where fellows spent the least time. Factors with the highest positive impact on the inpatient consultation experience included consult request early in the day, sufficient time to learn, and clarity of consult question while unpredictability of workload and perceived low necessity of the consult negatively impacted the experience.
Conclusions
The largest percentage of time spent by Internal Medicine subspecialty fellows is with direct inpatient care, with a significant proportion spent on clinical documentation and answering patient messages. Factors impacting fellow experience during inpatient consultation highlight the importance of pace of work, predictability of the workload, and ability to add value and to learn. Our findings offer insight for the development of interventions that may enhance the fellowship learning environment and reduce burnout.