Open Access Research article

Does doctors’ workload impact supervision and ward activities of final-year students? A prospective study

Nora Celebi1, Rodoula Tsouraki2, Corinna Engel3, Friederike Holderried4, Reimer Riessen5 and Peter Weyrich1*

Author Affiliations

1 Department of Internal Medicine, Division of Diabetes, Endocrinology, Angiology, Nephrology and Clinical Chemistry, University Hospital of Tübingen, Tübingen, Germany

2 University of Tübingen, Medical School, Tübingen, Germany

3 Institute for Medical Biometry, University of Tübingen, Tübingen, Germany

4 Department of the Dean of Student Affairs, University of Tübingen, Tübingen, Germany

5 Department of Internal Medicine, Medical Intensive Care Unit, University Hospital of Tübingen, Tübingen, Germany

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BMC Medical Education 2012, 12:24  doi:10.1186/1472-6920-12-24

Published: 27 April 2012



Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students.


A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question.


A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown.


There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.