Consider a resident whose scheduled teaching session is interrupted three times by ward tasks. They appear on the attendance sheet, yet never have time to work through the clinical problem being discussed. This imagined situation highlights a practical responsibility for training programmes: making the learning opportunities in a timetable accessible.
Among 181 internal medicine residents surveyed in Sudan in 2017–2018, 79.6% reported working over 80 hours weekly, while 80.1% did not understand the curriculum outline. Respondents also valued the patient volume. This cross-sectional study describes one programme’s trainees; it cannot establish causation or represent every specialty.
Workload needs a richer description than a patient count. In a longitudinal study at two US teaching hospitals, Haney and colleagues found that perceived learning was related to case variety and illness severity. The relationship with patient numbers varied by training level and task. These self-reported findings do not establish a universally optimal caseload.
For a local review, a programme might therefore examine the work within a shift: time spent assessing new admissions, repeated administrative tasks, opportunities to discuss uncertainty, and the availability of senior support. Looking at these activities separately could help identify where a change in organisation is worth testing.
The WFME’s 2015 postgraduate standards offer a useful foundation: training and service should be planned together, duty schedules should account for educational needs and continuity of care, and trainers should have time for teaching. Applying these principles requires agreement between those who organise the curriculum and those who run the ward.
One practical application would be a four-week pilot on a single rotation. Before it starts, the clinical team could choose one recurring teaching slot and agree how urgent calls will be covered. Residents and supervisors would identify a specific learning objective for each session. The rota should show both the teaching responsibility and the clinical cover, so participation is feasible for the teacher and trainee.
During the pilot, a brief record could capture sessions planned and completed, cancellations, interruptions and supervisor attendance. A cancellation should prompt a reason: urgent clinical demand, insufficient cover, conflicting commitments or a missing teacher. Each calls for a different response. A session repeatedly cancelled because nobody can cover the ward needs a staffing decision; a clash with another mandatory activity needs coordination.
A final review would examine both access and learning. Attendance records could show whether residents received the planned opportunity. Reviewing their reasoning on a subsequent case could help explore what they learned. The team should also check whether colleagues absorbed an unreasonable extra workload and whether opportunities were shared fairly across trainees. These are proposed ways to test an improvement locally, with its benefits and trade-offs made visible.