Reduced workload and increased participation of attendings associated with higher satisfaction of doctors in training

An experimental inpatient-medicine service was designed with reduced resident workload comprising two teams, with each team consisting of two attending physicians, two residents, and three interns.

Attending physicians, selected for their "teaching prowess", supervised the teams throughout the workday and during bedside team-teaching rounds.

This experimental model was compared with a control model comprising two teams, with each consisting of one resident and two interns, plus multiple supervising attending physicians who volunteered to participate.

Over a 12-month period, 1892 patients were assigned to the experimental teams and 2096 to the control teams; the average census per intern was 3.5 and 6.6 patients, respectively.

Overall satisfaction was significantly higher among trainees on the experimental teams than among those on the control teams (78% and 55%, respectively; P=0.002).

Interns on the experimental teams spent more time in learning and teaching activities than did interns on the control teams (learning: 20% of total time vs. 10%, P=0.01; teaching: 8% of total time vs. 2%, P=0.006).

A model with two attending physicians and limited patient-staff census resulted in greater satisfaction on the part of trainees and attending physicians than the standard approach.

Reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities.

Image source:, public domain.


  1. The control group had a per-intern average census of 6.6?! I'd be thrilled if this were my situation. In my program we regularly carry 10 patients on the floors (up to 14 on weekends) and dictate discharge summaries on our days off. We go to noon lecture just to sign our names so we can get back to work. We also come in at 5:30am and stay late, skip lunch, and pre-write our notes from home the evening before to have a prayer of being ready for rounds by 10 am. No wonder I feel like I'm not learning!

  2. Actually, the the average census per intern was 3.5 patients in the intervention group - even lower than 6.6.