Setting and Problem
Resident work hour restrictions are often a source of consternation for program directors, administrators, and residents alike. While policies regarding work hour limitations garner most of the attention, the actual reporting of work hours still relies on self-tracking and self-reporting by residents. This means that work hour reporting essentially operates on an “honor system,” despite the potential conflicts of interest for residents, leading some to question the accuracy of reported work hours.
Another factor affecting the accuracy of work hours is that it is genuinely difficult and laborious to track them. At most institutions, the resident is solely responsible to track their work hours. However, residents are often not given any tools to do so precisely. It is also very rare for work hours to be tracked in real time, which leads to many residents estimating their work hours post hoc, sometimes weeks later.
To combat this issue, a more proactive approach to assist residents in tracking work hours is sorely needed. Previous studies have explored the efficacy of work hours tracking by e-mail or text message. However, these methods still require the resident to actively perform a task to track their work hours (in this case, by clocking in and out via e-mail or text message). The need to actively perform an action may decrease compliance and accuracy. We believe that an automated mechanism to assist residents in work hours tracking would be helpful for all stakeholders in graduate medical education. Given the ubiquity of smartphones today, we propose an automated system that utilizes smartphone technology to achieve this goal.
Intervention
To help residents track work hours, we used the HoursTracker app (Cribasoft LLC, Round Rock, TX). This app uses geo-fencing technology to allow users to track their work hours by sensing the phone's location. A geo-fence is a virtual fence that is set up around a “work location.” This particular app uses Wi-Fi networks to set up the geo-fence. The app can detect changes in the Wi-Fi networks as a user moves in and out of the geo-fence, because each network has a unique identifier. The app does not connect to the specific Wi-Fi networks, although it does require Wi-Fi to be activated on the user's smartphone. Every physical location (eg, hospital, clinics, laboratory, etc) in which a resident works can be set as a “work location” with a reasonable radius around each work location set as the geo-fence. The app automatically clocks in residents when they enter their work location radius. Hours are automatically tallied by the app for easy tracking and reporting of work hours.
Outcomes to Date
After approval by our Institutional Review Board, we recruited 10 general surgery residents to participate in our 12-week pilot study. All participants completed the study survey. Prior to using the app, 80% of residents said that it was “too time-consuming to regularly report work hours,” and 40% said it was “difficult to accurately track work hours.” After using the app, 80% of respondents said the app was “extremely or moderately easy to use,” and 60% said it was “very or moderately accurate.” One resident noted that the app “does not include transportation time between sites.” In addition, this resident forgot their smartphone one day, so no hours were logged. However, residents are able to manually adjust tallied work hours if needed on the app. Despite these potential issues, this pilot study shows that a location-sensing time-keeping smartphone app can be used to assist residents in tracking work hours. The unobtrusive and automated nature of the app is an advantage over other work hour tracking systems previously tested and can potentially decrease the burden and increase the accuracy of reported work hours.
Figure.
Example of a Geo-Fence Set Around the Centroid of the Work Location