How Many Hours Do Internal Medicine Residents At University Of Toronto Spend Onboarding At Hospitals Each Year? A Cross-sectional Survey Study

Background Burnout among medical residents is common. One source of burnout is the need to complete redundant administrative tasks such as onboarding processes at various hospitals. Objectives To quantify the time residents at the University of Toronto spend onboarding at teaching hospitals, to identify areas of redundancy in onboarding processes, and to identify trainee perceptions of onboarding processes. Methods We conducted a quality improvement survey of core internal medicine residents at the University of Toronto where residents rotate through multiple different teaching hospitals. The primary outcome was time spent onboarding. Secondary outcomes included perceptions of the onboarding process, and impact on well-being. Results 41% (N=93) of all Internal Medicine residents completed the survey. Most (n=81, 87%) rotated through at least four hospitals and 24 (26%) rotated through more than 5 in the preceding year. The median number of hours spent on the onboarding process was 5 hours per hospital (IQR 1-8) and these tasks were often completed when trainees were post-call (82%, n=76) or outside of work hours (97%, n= 90). The cumulative number of hours spent each year on onboarding tasks by the 93 trainees was 2325 hours (97 days) which extrapolates to 5625 hours (234 days) for all 225 trainees in the core internal medicine program. Most residents reported high levels of redundancy across hospital sites (n=79, 85%) and felt that their well-being was negatively affected (73%, n=68). Conclusions The median internal medicine resident at the University of Toronto spent 5 hours onboarding for each hospital. There is considerable redundancy and the process contributes to self-reported burnout. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Upon review of the project, the Mount Sinai Hospital Research Ethics Board has determined that this activity is a Quality Improvement initiative and does not constitute research under Chapter 2 of the Tri-Council Policy Statement 2: Ethical Conduct for Research Involving Humans (TCPS2), and therefore does not fall within the scope of REB review. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript.