Picture a doctor-in-training navigating the dimmed corridors of a hospital at 2am, juggling patient reviews, procedure calls and countless tasks with minimal senior support. A South Australian study has now mapped exactly how these doctors spend every minute of their night shifts.

Researchers 10 shadowed trainee medical officers through 120 hours of night shifts at a metropolitan teaching hospital, recording every task, interruption and minute spent on 3,454 different activities. The study junior doctors spent just 0.4% of their time on education and supervision activities – less than 27 minutes across entire shifts.

Dr Lareesa Ryan (PhD). Source: University of Adelaide

“The small amount of time spent on provision of education and supervision in our study raises questions about barriers that may exist for trainee medical officers to seek and/or provide this when on night shifts,” said the authors, led by public health academic Dr Lareesa Ryan (PhD) from the University of Adelaide.

The study painted a clear picture of how junior doctors spend their after-hours time. Nearly half of their shifts were consumed by indirect care such as finding and reading patient records, preparing or collecting equipment, or searching for imaging.

Some 2.2 hours, or roughly 18% of each shift, was spent on direct patient care.

“This study shows that trainee medical officers are mostly spending their time on night shifts in three task areas – time on indirect care, direct care and professional communication,” the authors wrote in the Internal Medicine Journal [link here].

The single most time-consuming task? Reviewing patient notes, which swallowed nearly a quarter of shift time at 23.7%. Performing procedures took 10.1% of time, while reviewing results or planning care accounted for 8.2%.

The findings contrast sharply with day shift patterns. While daytime rosters typically dedicate around 7% of time to education and supervision, night shifts offered a fraction of that learning opportunity.

It also suggested an upside to the graveyard shift. Junior doctors working nights faced far fewer interruptions than their daytime counterparts – just one per hour compared to 4-7 interruptions hourly during day shifts reported in other research.

“Interruption rates and time spent multitasking during the night-shift were low in this study,” the authors observed, with multitasking accounting for just 7.8% of total time.

The study also revealed junior doctors spent more than 13% of their time simply walking between locations – more than double the proportion found in day shift studies. This may reflect “the lower number of doctors providing patient care during the night, the need for trainee medical officers to undertake tasks others would undertake in a day shift or the layout of the hospital,” the researchers suggested.

Time spent on social activities and fatigue management was notably low at less than 10% combined, which the researchers described as “concerning in terms of safety and well-being.”

The authors said they hoped their work would inform decisions around workloads to “ensure the safety of patients and trainee medical officers and improve health service delivery.”

The 10 trainee medical officers observed worked across surgical, medical and acute medical wards at a metropolitan teaching hospital with over 250 beds, serving as primary contact points for medical issues in admitted patients.