Perceived Impact of a Junior–Senior Inpatient Team Model on Clinical Workflow, Supervision, and Workload in a Tertiary Gastroenterology Department: A Mixed-Methods Study

TL;DR

A new team model for inpatient care improved junior doctors' access to supervision but increased senior doctors' workload.

Contribution

The study introduces a junior–senior team model in gastroenterology and evaluates its impact on workflow and supervision.

Findings

Junior physicians reported greater reassurance and reduced burden in managing critically ill patients.

Senior physicians faced increased supervisory demands and heavier weekend/holiday duties.

Flexible patient redistribution was emphasized as important during staffing variability.

Abstract

Background: In many inpatient settings, physician coverage is organized around single-attending responsibility, which can create challenges in supervision and workload distribution, particularly in procedurally intensive environments. To address these issues, our department introduced a junior–senior inpatient team model in which multiple physicians jointly share responsibility for hospitalized patients. This study examined physicians’ perceptions of how this restructuring influenced clinical workflow, supervision, and workload. Methods: We performed a mixed-methods cross-sectional survey two months after implementation. Twenty-two physicians (13 junior, 9 senior) completed five-point Likert-scale items and open-ended questions. Responses were analyzed using non-parametric group comparisons. Qualitative comments were examined thematically to identify recurring perspectives on supervision and workload. Results: Junior physicians reported more favorable perceptions across several domains. Significant differences between junior and senior physicians were observed for reassurance during off-site duties (p = 0.013) and perceived reduction in burden when managing critically ill patients (p = 0.002). Qualitative findings indicated that junior physicians experienced greater shared responsibility and easier access to consultation, whereas senior physicians described increased supervisory demands, responsibility extending beyond subspecialty areas, and heavier weekend or holiday duties. Both groups emphasized the importance of flexible patient redistribution during staffing variability. Conclusions: The junior–senior inpatient team model was associated with improved perceived accessibility of supervision and collective support for junior physicians while increasing supervisory demands on senior staff. These findings suggest the potential importance of workload-sensitive implementation strategies and explicit role definition when introducing physician team–based coverage in high-acuity inpatient settings.

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