Graduate Medical Education What Do Residents Do When Not Working or Sleeping? A Multispecialty Survey of 36 Residency Programs DeWitt C. Baldwin, Jr., MD, Steven R. Daugherty, PhD, Patrick M. Ryan, MD, and Nicholas A. Yaghmour Abstract Purpose To determine how residents spend their time when not working or sleeping, and to examine correlates of these outside activities. Method In 2009, the authors surveyed 36 internal medicine, surgery, pediatrics, and obstetrics– gynecology programs. Residents answered questions about their recently completed first and second residency years, including, “During your past year of residency, outside of working hours, about how often did you…,” followed by 10 listed activities and a four-point rating scale (1 = “less than once a week”; 4 = “almost daily”). Results The most frequent activity reported across all 634 respondents was using the Internet, followed by watching television and doing household tasks. The lowest reported activity was moonlighting, followed by seeing a movie. K-cluster analyses divided residents into three clusters: (1) “Friend Focused,” reporting higher means for time with friends, Internet use, physical exercise, and watching television, (2) “Family Focused,” reporting higher means for time with family, Internet use, household tasks, and watching television, and (3) “Low Activity,” reporting the lowest ratings for all activities. Comparisons among these three clusters showed the Low Activity residents to have significantly higher scores on validated depression, anxiety, and sleepiness scales; higher stress; more reported work hours and sleep deprivation; and lower ratings for satisfaction, time with attendings, and learning. Scores for Friend-Focused and Family-Focused clusters were similar to each other. Conclusions These data provide new information about the residency experience and suggest that activities outside of work and sleep hours correlate highly with residents’ mood, learning, and satisfaction. If you ask busy residents what they do with their free time, they are likely to reply, “What free time?” Historically, graduate medical education research has focused solely on what residents do during their working or on-duty hours. More recently, concerns over patient safety have directed investigators’ attention to the effects of sleep deprivation and fatigue on clinical performance, personal health, and medical errors. 1–3 To date, however, researchers have paid little attention to what residents do with their nonwork and nonsleep time. The 2003 Accreditation Council for Graduate Medical Education (ACGME) 80-hour-per-week limits for resident work hours were, in part, intended to give residents more opportunity for sleep in an effort to counter rising concerns that medical errors are frequently the result of sleep deprivation and fatigue. 4 Our own research in 1999 demonstrated that when residents moved from their first postgraduate year (PGY) to their second, they gained an extra hour of nonwork time per day. On average, however, the PGY-2 residents reported using only 13.8 minutes of this time for extra sleep; they used the rest for other activities. 1,5 The results of our 1999 national survey provided data from residents in multiple specialties on their work and sleep hours in the context of the full 168 hours available weekly. 5 Large differences were evident in the average self-reported weekly work hours across the 22 specialties in our survey, ranging from a high of 110.6 hours per week for neurosurgery to a low of 56.7 hours for pathology. When we added the self- reported average weekly sleep hours to these work hours for each specialty, we found equally large differences in the time remaining (i.e., residents’ free time)—about which we had no information. We found wide variation in the hours of time remaining, ranging from as few as 23.8 hours per week of nonwork and nonsleep time for neurosurgical residents to 63.2 hours per week for pathology residents—The difference between the two is nearly threefold. 5 PGY-1 residents averaged 44.7 hours a week of such residual time, whereas PGY-2 residents reported 49.9 hours of such time, a significant difference of 5.16 hours per week (P  .001). 1 Since the advent of the 2003 ACGME rules limiting work hours in a given week, the amount of nonwork, nonsleep time available per week has increased substantially. 6,7 We are not aware of other research that looks specifically at how residents spend this nonwork, nonsleep time. Some of the literature discussing the residency training experience has used the term Dr. Baldwin is scholar-in-residence, Education Division, Accreditation Council for Graduate Medical Education, Chicago, Illinois. Dr. Daugherty is adjunct professor, Psychology Department, Rush University Medical School, Chicago, Illinois. Dr. Ryan is pediatric resident, University of Oklahoma, Tulsa, Oklahoma. Mr. Yaghmour is master of public policy candidate, Harris School of Public Policy, University of Chicago, Chicago, Illinois. Correspondence should be addressed to Dr. Baldwin, Accreditation Council for Graduate Medical Education, 515 North State St., Suite 2000, Chicago, IL 60654; telephone: (312) 755-5019; fax: (312) 755-7498; e-mail: dbaldwin@acgme.org. Acad Med. 2012;87:395–402. First published online February 22, 2012 doi: 10.1097/ACM.0b013e318249638b Academic Medicine, Vol. 87, No. 4 / April 2012 395