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More in not necessarily better
Effects of 2- vs. 4-Week Attending Physician I patient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout. Lucas BPet al. JAMA 2012;308(21):2199-2207.


Reviewed by Linda Lewin

What is the study question?
Does having internal medicine inpatient attending physicians on two-week "on-service" rotations lead to significantly different medical (shorter length of stay, less unplanned revisits), educational (ratings of attendings' teaching and ability to evaluate trainees) and personal (self-reported burnout) outcomes compared to having them on four-week rotations?

How was the study done?
During one academic year, internal medicine inpatient attendings were assigned to at least one 2-week and one 4-week block on service. Patient care outcomes: Length of stay and unplanned patient revisits (readmissions, unplanned ED and clinic visits) were measured. Educational outcomes: Residents and medical students rated the attendings at the end of their rotations. Personal outcomes: Attendings completed a questionnaire at the end of their rotations assessing their levels of burnout. Outcomes for all of these measures were compared using data from 2-week and 4-week blocks.

What were the results?
There were no differences in unplanned revisits or patient length of stay whether the attending physician was doing a 2- or 4-week rotation. Residents and medical students were significantly more likely to say that the 4-week attendings were better able to evaluate them and that their teaching was better (particularly true of medical students). Attending physician self-reported measures of burnout were significantly higher on the 4-week rotations.

What are the implications of these findings?
The higher ratings of attending physicians by trainees are almost exactly countered by the increased burnout that attending physicians experience on 4-week rotations as compared to 2-week rotations. This clarifies the effect of scheduling on different stakeholders. As we strive to create the best learning opportunities for students we need to balance their needs with those of our teachers and patient care providers.

Editor's note: While this study focused on internal medicine teams, I'm sure the results and implications can inform our pediatric world. This study illustrates the classic dilemma of not being able to satisfy everyone all of the time. I would favor the 2-week rotations for I believe that supporting our preceptors well is one way of ensuring they will provide an outstanding experience for their trainees (SLB).

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