Impact of medical student teaching on family physicians' use of time.

BACKGROUND: The purpose of this study was to determine how much and in what ways family physicians' time at work is affected by the presence of a medical student in the practice.
METHODS: The study included work sampling of 22 non-academic family physicians, each observed during 1 day with and 1 day without a medical student, and 12 academic family physicians, of whom nine were observed for 8 half-days and three for 2 or 4 half-days of clinical practice. Observations were made on average every 4 minutes at preselected random times during the workday.
RESULTS: When a student was present at the practice, the amount of time private physicians actually spent working increased by 52 minutes per day, and their patient-care productivity decreased from 3.9 to 3.3 patients per hour. There was no significant change in time spent at work for academic physicians. With a student present, the physicians in private practice spent 27 fewer minutes per day in patient-care activities, whereas academic physicians spent 47.5 fewer minutes per day in these activities. Private and academic physicians spent 71 and 63 minutes per day, respectively, in student-centered activities. There were few differences between physician groups in how this direct teaching time was used.
CONCLUSIONS: When a student is in the practice, private family physicians shift substantial amounts of work time from patient-centered to student-centered activities. They also use their personal time for teaching activities and experience a decrease in patient-care productivity of 0.6 patients per hour.