Multitasking or distracted? Surgery resident engagement with the EHR during protected education time

Abstract Purpose Accreditation Council for Graduate Medical Education residency requirements stipulate that programs must define core didactic activities during which residents are protected from clinical responsibilities. It is not well understood if residents are able to disengage from clinical duties during dedicated education. This study aimed to evaluate residents’ engagement with the electronic health record (EHR) during protected educational didactic time using EHR audit logs. Methods All EHR activity logs of general surgery residents at a single academic institution were pulled from 11/2022-6/2023. All interactions during protected didactics over those months (~3 h weekly) were included. Residents were evaluated individually or grouped by postgraduate year (PGY) and EHR activities were identified as mobile application or desktop-specific access for analysis. Results The EHR activities of 28 general surgery residents over 56.5 didactic hours were analyzed. All 28 residents spent some amount of protected time engaged with the EHR. Cumulatively, there were 5,721 mobile interactions, accounting for 36.6 h (2.4%) of didactic time. A total of 39.9 h (2.5%) were desktop-specific access outside of the didactic lecture hall. All PGY used the mobile application more frequently than a desktop with PGY-3 and PGY-4 residents demonstrating the highest rates (PGY-5: 50.9%, PGY-4: 60.0%, PGY-3: 62.7%, PGY-2: 54.4%, PGY-1: 57.3%, p <0.0001). PGY-4 and PGY-2 residents spent more total time on desktop-specific access; however, this difference was ameliorated when excluding desktop access for trauma or intensive care unit rotations. An equal proportion of didactic time was spent overall on the EHR across all PGYs (PGY-5: 3.7%, PGY-4: 5.0%, PGY-3: 5.6%, PGY-2: 5.1%, PGY-1: 4.8%, p =0.07). Similarly, there was an equal distribution of time spent on mobile versus desktop engagement by individual resident. A higher proportion of mobile interactions among junior residents were spent on the encrypted messenger feature. Conclusions While continual access to the EHR allows for quick response time to clinical concerns, surgery residents struggle to disengage during protected didactic time. In addition to repeated distractions from education, residents are at times pulled away completely for desktop access. Additional work is warranted to study all clinical interruptions during protected time and methods to mitigate these disturbances