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Nagasaki K, Kobayashi H. The effects of resident work hours on well-being, performance, and education: A review from a Japanese perspective. J Gen Fam Med 2023; 24:323-331. [PMID: 38025934 PMCID: PMC10646297 DOI: 10.1002/jgf2.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
This article examines the impact of working-hour restrictions on the well-being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80-hour-per-week regulation in the United States and the 48-h-per-week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working-hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working-hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
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Gates RS, Kemp MT, Evans J, Liesman D, Pumiglia L, Matusko N, George BC, Sandhu G. The Demands of Surgery Residency: More Than Just Duty Hours? J Surg Res 2023; 290:293-303. [PMID: 37327639 DOI: 10.1016/j.jss.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Efforts to improve surgical resident well-being could be accelerated with an improved understanding of resident job demands and resources. In this study, we sought to obtain a clearer picture of surgery resident job demands by assessing how residents distribute their time both inside and outside of the hospital. Furthermore, we aimed to elucidate residents' perceptions about current duty hour regulations. METHODS A cross-sectional survey was sent to 1098 surgical residents at 27 US programs. Responses regarding work hours, demographics, well-being (utilizing the physician well-being index), and perceptions of duty hours in relation to education and rest, were collected. Data were evaluated using descriptive statistics and content analysis. RESULTS A total of 163 residents (14.8% response rate) were included in the study. Residents reported a median total patient care hours per week of 78.0 h. Trainees spent 12.5 h on other professional activities. Greater than 40% of residents were "at risk" for depression and suicide based on physician well-being index scores. Four major themes associated with education and rest were identified: 1) duty hour definitions and reporting mechanisms do not completely reflect the amount of work residents perform, 2) quality patient care and educational opportunities do not fit neatly within the duty hour framework, 3) resident perceptions of duty hours are impacted the educational environment, and 4) long work hours and lack of adequate rest negatively affect well-being. CONCLUSIONS The breadth and depth of trainee job demands are not accurately captured by current duty hour reporting mechanisms, and residents do not believe that their current work hours allow for adequate rest or even completion of other clinical or academic tasks outside of the hospital. Many residents are unwell. Duty hour policies and resident well-being may be improved with a more holistic accounting of resident job demands and greater attention to the resources that residents have to offset those demands.
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Affiliation(s)
- Rebecca S Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Julie Evans
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel Liesman
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Luke Pumiglia
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Marsch A, Khodosh R, Porter M, Raad J, Samimi S, Schultz B, Strowd LC, Vera L, Wong E, Smith GP. Implementing patient safety and quality improvement in dermatology. Part 1: Patient safety science. J Am Acad Dermatol 2023; 89:641-654. [PMID: 35143912 DOI: 10.1016/j.jaad.2022.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/23/2022]
Abstract
Patient safety (PS) and quality improvement (QI) have gained momentum over the last decade and are becoming more integrated into medical training, physician reimbursement, maintenance of certification, and practice improvement initiatives. While PS and QI are often lumped together, they differ in that PS is focused on preventing adverse events while QI is focused on continuous improvements to improve outcomes. The pillars of health care as defined by the 1999 Institute of Medicine report "To Err is Human: Building a Safer Health System" are safety, timeliness, effectiveness, efficiency, equity, and patient-centered care. Implementing a safety culture is dependent on all levels of the health care system. Part 1 of this CME will provide dermatologists with an overview of how PS fits into our current health care system and will include a focus on basic QI/PS terminology, principles, and processes. This article also outlines systems for the reporting of medical errors and sentinel events and the steps involved in a root cause analysis.
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Affiliation(s)
- Amanda Marsch
- University of California, San Diego Medical Center, San Diego, California
| | - Rita Khodosh
- Department of Dermatology, University of Massachusetts, Boston, Massachusetts
| | - Martina Porter
- Department of Dermatology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jason Raad
- American Academy of Dermatology, Rosemont, Illinois
| | - Sara Samimi
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brittney Schultz
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Laura Vera
- American Academy of Dermatology, Rosemont, Illinois
| | - Emily Wong
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Gideon P Smith
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
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Conner SM, Choi N, Fuller J, Daya S, Barish P, Rennke S, Harrison JD, Narayana S. Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives. RESEARCH SQUARE 2023:rs.3.rs-2982838. [PMID: 37333324 PMCID: PMC10275050 DOI: 10.21203/rs.3.rs-2982838/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the modern clinical learning environment, tension exists when this balance is skewed. This study aimed to understand the current and ideal states of autonomy and supervision, then describe the factors that contribute to imbalance from both trainee and attending perspectives. Methods A mixed-methods design included surveys and focus groups of trainees and attendings at three institutionally affiliated hospitals between May 2019-June 2020. Survey responses were compared using chi-square tests or Fisher's exact tests. Open-ended survey and focus group questions were analyzed using thematic analysis. Results Surveys were sent to 182 trainees and 208 attendings; 76 trainees (42%) and 101 attendings (49%) completed the survey. Fourteen trainees (8%) and 32 attendings (32%) participated in focus groups. Trainees perceived the current culture to be significantly more autonomous than attendings; both groups described an "ideal" culture as more autonomous than the current state. Focus group analysis revealed five core contributors to the balance of autonomy and supervision: attending-, trainee-, patient-, interpersonal-, and institutional-related factors. These factors were found to be dynamic and interactive with each other. Additionally, we identified a cultural shift in how the modern inpatient environment is impacted by increased hospitalist attending supervision and emphasis on patient safety and health system improvement initiatives. Conclusions Trainees and attendings agree that the clinical learning environment should favor resident autonomy and that the current environment does not achieve the ideal balance. There are several factors contributing to autonomy and supervision, including attending-, resident-, patient-, interpersonal-, and institutional-related. These factors are complex, multifaceted, and dynamic. Cultural shifts towards supervision by primarily hospitalist attendings and increased attending accountability for patient safety and systems improvement outcomes further impacts trainee autonomy.
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Analysis of one- versus two-staged reconstruction in head and neck cancer patients: What are the benefits? J Plast Reconstr Aesthet Surg 2023; 81:76-82. [PMID: 37121045 DOI: 10.1016/j.bjps.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/29/2023] [Indexed: 02/08/2023]
Abstract
In head and neck oncology, surgical treatment frequently results in microvascular reconstruction. Oncologic resection followed by immediate reconstruction is often associated with prolonged working and surgical duration, challenging a surgeon's concentration level and potentially worsening patient outcome. To improve the surgeon's performance and to reduce risk of potential complications, we implemented a two-stage procedure in patients with head and neck cancer. This study critically analyzed the surgical outcomes, organizational benefits, and investigated job satisfaction among affected health care professionals. A retrospective data analysis of patients who had undergone microvascular reconstruction after oncologic head and neck surgery between 2010 and 2021 included 33 patients (n = 33). Twenty patients underwent single-stage reconstruction (group 1, n = 20) and 13 patients underwent two-stage reconstruction (group 2, n = 13) with 12.2 (± 7.4) days between surgeries. The mean surgical duration, and mean start and end time of the reconstructive surgery component differed significantly (p = 0.002). The mean total complication rate (p = 0.58) did not differ significantly, although a trend toward higher demands for blood products was observed in group 1. There was no significant difference in five-year survival (p = 0.28). A questionnaire on subjective work performance was answered by the affected health care professionals (n = 34) and it revealed that 88% preferred long surgeries to be scheduled first and that 97% work most efficiently in the morning. In conclusion, two-stage reconstruction is a suitable option in selected head and neck cancer patients offering the possibility of optimizing preoperative planning and organization. This may result in regular working hours, reduced surgeon fatigue, and improved job satisfaction without compromising patient outcomes or survival.
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Tarrash M, Nelson D, Gabbur N, Goldberg GL. Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital. BMC MEDICAL EDUCATION 2022; 22:809. [PMID: 36424600 PMCID: PMC9686460 DOI: 10.1186/s12909-022-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout. OBJECTIVE To determine the rates of burnout among residents working night rotations versus day rotations. METHODS This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test. RESULTS A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights. CONCLUSIONS Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.
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Affiliation(s)
- Miriam Tarrash
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - David Nelson
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Nagaraj Gabbur
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Gary L Goldberg
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA.
- Department of Obstetrics & Gynecology LIJ Medical Center, Ob/Gyn Admin Suite Room C221, 270-05 76th Avenue, New Hyde Park, New York, NY, 11040, USA.
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Khalil IA, Ibrahim T, Aldeeb M, Mohamed A, Ben Salah R, Aboumarzouk OM, Al-Naimi A. Urology Residents’ Perspectives on the In-House On-Call Systems: A Study in an Accredited Academic Center. Qatar Med J 2022; 2022:49. [PMCID: PMC9653301 DOI: 10.5339/qmj.2022.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Medical education and training are crucial in maintaining patients’ safety and improving patient care quality. Multiple studies have evaluated the effects of restrictive policies on the resident's quality of life and education. Due to the compiling data and the fact that these trials evaluated programs with a substantial number of residents, it remains uncertain whether these conclusions can be extended to urology programs with a small number of residents. Multiple on-call systems have been adopted in residency programs across the world. This study evaluated the residents’ quality of life, clinical experience, and education upon transitioning from 24-hour to 12-hour in-house on-call systems. Methods and materials: In this observational and questionnaire-based study, the effect of the transition from 24-hour to 12-hour in-house on-call systems was compared in terms of the resident's quality of life and education, surgical case volume, and working hours’ rules compliance. Quality of life and education: We adopted a validated survey based on a 5-point Likert scale to assess the residents’ perception of the transition to a 12-hour on-call system on their quality of life and education. Surgical case volume: We extracted the number of cases the residents operated on from the operating theater database at our institution. Working hours: compliance and violations: The weekly working hours, compliance, and violations per ACGME-I rules were collected from the MedHub platform. Results: Quality of life and education: Residents rated the 12-hour on-call system superior in terms of quality of life, education, and surgical case volume. Surgical case volume: There was a 45% increment in the surgical case volume (p = 0.04) with the 12-hour on-call system.
Working hours: compliance and violations
There was no significant difference in the mean weekly working hours (p = 0.1). However, the total number of duty hours violations decreased in the 12-hour on-call system. Conclusion: The 12-hour system is a better alternative to the 24-hour system in terms of the resident's quality of life, education, surgical case volume, and compliance with duty hour rules.
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Affiliation(s)
- Ibrahim A. Khalil
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail: ,E-mail:
| | - Tarek Ibrahim
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohamed
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | - Rym Ben Salah
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
| | | | - Abdulla Al-Naimi
- Department of Urology, Hamad medical corporation, Doha, Qatar E-mail:
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Warner MA, Arnal D, Cole DJ, Hammoud R, Haylock-Loor C, Ibarra P, Joshi M, Khan FA, Lebedinskii KM, Mellin-Olsen J, Miyasaka K, Morriss WW, Onajin-Obembe B, Toukoune R, Yazbeck P. Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030. Anesth Analg 2022; 135:6-19. [PMID: 35389378 DOI: 10.1213/ane.0000000000006028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.
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Affiliation(s)
- Mark A Warner
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Arnal
- Department of Anesthesiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Daniel J Cole
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California
| | - Rola Hammoud
- Department of Anesthesiology, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Carolina Haylock-Loor
- Department of Anesthesiology, Critical Care, and Pain Medicine, Hospital del Valle, San Pedro Sula, Honduras
| | - Pedro Ibarra
- Department of Anesthesiology and Perioperative Medicine, Clínica Reina Sofía, Bogota, Colombia
| | | | - Fauzia A Khan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Konstantin M Lebedinskii
- Department of Anaesthesiology and Reanimatology, North-Western State Medical University, St Petersburg, Russia.,Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | | | - Katsuyuki Miyasaka
- Department of Anesthesiology, St Luke's International University, Tokyo, Japan
| | - Wayne W Morriss
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Bisola Onajin-Obembe
- Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
| | - Robinson Toukoune
- Department of Anaesthesia, Vila Central Hospital, Port Vila, Vanuatu
| | - Patricia Yazbeck
- Department of Anesthesiology and Critical Care, Saint Joseph's University; Beirut, Lebanon
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Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Kataoka K, Tokuda Y, Kobayashi H. Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. Sci Rep 2022; 12:10626. [PMID: 35739229 PMCID: PMC9218701 DOI: 10.1038/s41598-022-14952-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022] Open
Abstract
The new duty hour (DH) limit for doctors in Japan will begin in 2024, setting the maximum DHs for postgraduate residents at approximately 80 h weekly. To set appropriate limits, understanding the association between DHs and psychological health is necessary. Thus, we assessed the relationship between residents' psychological health and DHs. We conducted a cross-sectional study involving examinees of the General Medicine In-training Examination 2020. Mental health outcomes were measured dichotomously using the Patient Health Questionnaire-2 for depression and Mini-Z 2.0, for burnout, stress, and satisfaction. Weekly DHs were measured in seven categories at 10-h intervals. The prevalence ratios (PRs) between the DH categories were estimated for each outcome. Of the 6045 residents who provided data on DHs and psychological outcomes, 37.3% showed signs of depression, 21.6% experienced burn out, and 39.2% were highly stressed. In contrast, 62.3% were highly satisfied with their training. Proportions of burnout were higher among residents in Category 6 (≥ 90 and < 100 h; PR 1.36; 95% CI 1.11-1.66) and Category 7 (≥ 100 h; PR 1.36; 95% CI 1.10-1.68) compared with residents in Category 3 (≥ 60 and < 70 h; reference). The results partially support the weekly 80-h DH limit in terms of resident well-being.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan.
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10
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Wellness in Graduate Surgical Medical Education. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Glick H, Ganesh Kumar N, Olinger TA, Vercler CJ, Kraft KH. Resident Mental Health and Burnout: Current Practices and Perspectives of Urology Program Directors. Urology 2021; 160:40-45. [PMID: 34863792 DOI: 10.1016/j.urology.2021.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To understand perspectives of urology program directors (PDs) regarding the management and screening of resident mental health and burnout. METHODS After piloting and survey validation, an IRB-exempt 14 question survey was distributed to PDs of all 145 ACGME accredited urology residency programs. Statistical significance was determined using an alpha value of 0.05 and response plurality was determined by non-overlapping 95% confidence intervals. RESULTS A total of 72 PDs completed the survey (response rate = 49.6%). The majority of PDs (59.7%) do not use standardized screening for resident burnout or mental health. A statistically significant proportion of PDs agreed to implementing periodic mental health (75.0%, 95% CI [65.0%-75.0%]) and burnout (87.6%, 95% CI [79.9%-95.1%]) screening. Female PDs were more likely to agree to implementing mental health screening compared to male PDs (female=94.4% vs male=68.5%; P =.03). If mental health screening was implemented and a resident tested positive, PDs were most concerned about harm to a patient (72.2%, 95% CI [61.9-82.6]) and implications of a positive screen on future licensing and practice (55.6%, 95% CI [44.1-67.0]). CONCLUSION Although the majority of urology PDs believe residents should be periodically screened for burnout and mental health, most do not currently screen their trainees. If mental health screening was implemented, PDs expressed concern about patient harm and challenges associated with future licensing. Our survey results suggest opportunities for improving management of resident burnout and mental health.
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Affiliation(s)
- Hannah Glick
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Thomas A Olinger
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Christian J Vercler
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI.
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12
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Sholtes D, Kravitz HM, Deka A, Westrick J, Fogg LF, Gottlieb M. Optimising sleep and performance during night float: A systematic review of evidence and implications for graduate medical education trainees. J Sleep Res 2020; 30:e13212. [PMID: 33058426 DOI: 10.1111/jsr.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Abstract
Graduate medical education (GME) training commonly requires residents and fellows to engage in night float shift work. This review aims to assess the effectiveness of interventions for trainees when preparing for, completing, and recovering from working night float shifts. We reviewed all available studies published prior to September 2019 using PubMed, Scopus, CINAHL, the Cochrane library, PsycINFO, and Google Scholar databases. We included all original, primary research articles assessing either non-pharmacological or pharmacological interventions on the chronobiological and physiological effects of night float shift work among GME trainees. Five studies (n = 179 patients) met inclusion criteria. Interventions included melatonin in the morning before sleep after night float shifts, napping during night float shifts, modafinil after a night of sleep deprivation, and caffeinated energy drinks after 6 consecutive night float shifts. Melatonin improved one measure of attention. A 2-hr nap was associated with improved speed related to task switching. Modafinil improved performance in tests of cognition. Caffeinated energy drinks led to improvement in select driving performance variables and reaction time. Effect sizes for outcome variables were calculated. Heterogeneity among the studies precluded combining the data in a meta-analysis. According to GRADE criteria, the quality of the evidence in these studies was low or very low. Our findings suggest GME trainees may benefit from utilising a limited number of interventions when preparing for or recovering from night float shift work. More investigation is needed to identify interventions that could help GME trainees adapt to and recover from working night float shifts.
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Affiliation(s)
- David Sholtes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Aniruddha Deka
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Westrick
- Library of Rush University Medical Center, Rush University Medical Center, Chicago, IL, USA
| | - Louis F Fogg
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Williams-Karnesky RL, Greenbaum A, Paul JS. Surgery Resident Wellness Programs: The Current State of the Field and Recommendations for Creation and Implementation. Adv Surg 2020; 54:149-171. [PMID: 32713427 DOI: 10.1016/j.yasu.2020.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Alissa Greenbaum
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Jasmeet S Paul
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA; Division of Acute Care Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Rittenschober-Böhm J, Bibl K, Schneider M, Klasinc R, Szerémy P, Haidegger T, Ferenci T, Mayr M, Berger A, Assadian O. The association between shift patterns and the quality of hand antisepsis in a neonatal intensive care unit: An observational study. Int J Nurs Stud 2020; 112:103686. [PMID: 32703686 DOI: 10.1016/j.ijnurstu.2020.103686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Healthcare-associated infections represent a major burden in neonatal intensive care units. Hand antisepsis is the most important tool for prevention, however, compliance among healthcare workers remains low. OBJECTIVES To prospectively evaluate the influence of different work shifts (extended working hours, night shifts) on the quality of healthcare workers' hand antisepsis. DESIGN Observational study. SETTINGS Two equivalent "Level III" neonatal intensive care units at the University Hospital Vienna, Austria. PARTICIPANTS Seventy healthcare workers, 46 nurses and 24 physicians. METHODS The Semmelweis Scanner, an innovative training device assessing the quality of hand antisepsis with an ultraviolet dye labelled alcohol-based hand rub, was employed to collect data on the hand surface coverage achieved during hand antisepsis of participants. It provides visual feedback of appropriately versus inappropriately disinfected areas of the hand and can also be used for the objective quantification of hand surface coverage with the hand rub. Measurements were performed before and after 12.5 h (h) day and night shifts (nurses), as well as before and after regular 8 h day shifts and extended 25 h shifts (physicians). To avoid any bias caused by residual ultraviolet marker, scans had to be separated by 24 h periods. Primary outcome was the hand surface coverage with the hand rub: Hand scans were categorized as "passed" if an appropriate quality of hand hygiene, defined as a minimum 97% coverage of hand surface, was achieved. A generalized mixed model was used to analyse the data accounting for repeated measurements. RESULTS Seventy healthcare workers performed a total of 485 scans. Nineteen scans had to be excluded, resulting in 466 scans for further analyses. A difference in the predicted probability of achieving appropriate hand antisepsis was found between the beginning and end of extended shifts: In physicians, adequate hand antisepsis was remarkably reduced after 25 h shifts (predicted probability 99.4% vs 78.8%), whereas there was no relevant difference between the beginning and end of 8 h day shifts (92.2% vs 97.3%). In nurses, a relevant difference was found between the beginning and end of 12.5 h day shifts (88.6% vs 73.6%). This difference was not found for 12.5 h night shifts. The most frequently missed area on the hands was the right dorsum. CONCLUSION The quality of hand antisepsis of healthcare workers in neonatal intensive care units may be associated with long working hours.
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Affiliation(s)
- Judith Rittenschober-Böhm
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Centre for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Katharina Bibl
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Centre for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Schneider
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Centre for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Romana Klasinc
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | | | - Tamas Haidegger
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria; University Research, Innovation and Service Centre (EKIK), Óbuda University, Budapest, Hungary
| | - Tamas Ferenci
- John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Michaela Mayr
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Centre for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria; HandInScan Zrt, Debrecen, Hungary; Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria; University Research, Innovation and Service Centre (EKIK), Óbuda University, Budapest, Hungary; John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary; Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, United Kingdom
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Centre for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Ojan Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria; Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, United Kingdom
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16
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Jean WC, Ironside NT, Felbaum DR, Syed HR. The Impact of Work-Related Factors on Risk of Resident Burnout: A Global Neurosurgery Pilot Study. World Neurosurg 2020; 138:e345-e353. [DOI: 10.1016/j.wneu.2020.02.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/08/2023]
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17
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Ranji SR. What Gets Measured Gets (Micro)managed. JAMA 2020; 323:1688-1689. [PMID: 32369138 DOI: 10.1001/jama.2020.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sumant R Ranji
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
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Moura FS, Ita de Miranda Moura E, Pires de Novais MA. Physicians' working time restriction and its impact on patient safety: an integrative review. Rev Bras Med Trab 2020; 16:482-491. [PMID: 32754663 PMCID: PMC7394539 DOI: 10.5327/z1679443520180294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/22/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although shift work is a part of the physicians' routine, there is controversy on the length of shifts and adequate rest for safe professional practice. If on the one hand long working hours might have negative impact on patient safety by interfering with the psychological and physical functioning of physicians, on the other shorter working hours might impair the safety of patients due to interference with the continuity of care. OBJECTIVE To analyze the impact of restrictions to physicians' working hours on patient safety. METHOD Integrative literature review in which we surveyed studies on restriction to physicians' working time and patient safety included in databases National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) until May 2018. Thirty-five studies which met the inclusion criteria were included. RESULTS Patient safety outcomes analyzed in the included studies were mortality, adverse events, continuity of care, in-hospital complications, readmission rate and length of stay at hospital. Restriction to working time was associated with variable impact on patient safety indicators, but often did not modify their performance. CONCLUSION Restrictions to physicians' working time did not always improved patient safety indicators. Focusing on interventions which only seek to limit the workload of physicians might be insufficient to bring consistent improvement to patient care.
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Affiliation(s)
- Felipe Scipião Moura
- Department of Medicine, Universidade Federal de São Paulo – São Paulo (SP), Brazil
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19
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2011 ACGME Duty Hour Limits had No Association With Breast Reconstruction Complications. J Surg Res 2020; 247:469-478. [DOI: 10.1016/j.jss.2019.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/29/2019] [Accepted: 09/25/2019] [Indexed: 11/22/2022]
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Al-Kofahi M, Mohyuddin GR, Taylor ME, Eck LM. Reducing Resident Physician Workload to Improve Well Being. Cureus 2019; 11:e5039. [PMID: 31501731 PMCID: PMC6721886 DOI: 10.7759/cureus.5039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Resident physician’s well-being has been postulated to worsen with longer shifts. At our institution, the admitting physician evening shift (known as short call) had been associated with higher levels of stress and reduced well-being among residents due to longer work hours and an excessive number of admissions. We introduced an intermediate swing shift to help mitigate those effects. This study sought to assess the outcomes of introducing the swing shift on the timeliness of leaving the hospital for the short call physician, and the median number of admissions done by the short call, swing shift, and night shift resident physicians. Method The swing shift was designed to cover admitting duties from 4:00 to 11:00 pm on weekdays, with support from both the short call and night shift resident physicians. Internal Medicine residents in their second or third year of training and combined Medicine/Psychiatry residents in their third, fourth or fifth year of training, were surveyed prior to the implementation of the swing shift and four-months post-implementation. Time of leaving the hospital and number of admissions before and after the introduction of the swing shift were compared. Data were recorded as frequencies and presented as medians. Results There were 27 surveys completed prior to swing shift implementation and 43 surveys completed post-implementation with a response rate of 52% and 83%, respectively. Surveys post-implementation were divided into 29 for the short call shift survey, six for the swing shift survey, and eight for the night shift survey. Residents who did not perform the short call physician duties were excluded, limiting the prior to implementation surveys from 27 to 25 and the post-implementation short call surveys from 29 to 19. Prior to swing shift implementation, the median time of leaving for the short call physician was 8:30 to 9:00 pm; the median number of admissions were four and eight, done by short call physician and night shift physician, respectively. Whereas post-swing shift implementation, the median time of leaving for short call physician was 7:00 to 7:30 pm, and for swing shift physician was 11:30 pm to midnight. The median number of admissions were two, five, and five done by the short call, swing shift, and night shift physicians, respectively. All residents reported the swing shift allowed them to take better care of patients and follow up on their tasks. Discussion and conclusion Delayed resident physicians departure at the end of their respective shift was associated with extended shifts. It is thought to be caused by an increased number of admissions, late shift admissions, and time of day shift with 4:00 to 9:00 pm being the busiest. The addition of the swing shift increased the ability of the short call resident physician to leave the hospital at the end of their shift and reduced the median number of admissions done by the short call and night shift resident physicians, hence likely improving resident’s well-being while preserving the total number of admissions.
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Affiliation(s)
- Mejalli Al-Kofahi
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | | | - Melissa E Taylor
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | - Leigh M Eck
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
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22
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Houchens N, Meddings J, Gupta A. Quality and safety in the literature: September 2019. BMJ Qual Saf 2019; 28:769-774. [PMID: 31253735 DOI: 10.1136/bmjqs-2019-009918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Jennifer Meddings
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States.,Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Wachter RM, Murray SG, Adler-Milstein J. Restricting the Number of Open Patient Records in the Electronic Health Record: Is the Record Half Open or Half Closed? JAMA 2019; 321:1771-1773. [PMID: 31087007 DOI: 10.1001/jama.2019.3835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Sara G Murray
- Department of Medicine, University of California, San Francisco
- UCSF Health Informatics, University of California, San Francisco
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco
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Eid SM, Ponor L, Reed DA, Beydoun MA, Beydoun HA, Wright S. Associations Between In-Hospital Mortality, Health Care Utilization, and Inpatient Costs With the 2011 Resident Duty Hour Revision. J Grad Med Educ 2019; 11:146-155. [PMID: 31024645 PMCID: PMC6476098 DOI: 10.4300/jgme-d-18-00415.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/12/2018] [Accepted: 01/16/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) has mandated revisions to residents' work hours to improve patient safety and enhance resident education and wellness. The impact on clinical outcomes on a national level is poorly understood. OBJECTIVE We examined data from before and after the ACGME 2011 duty hour revision and looked for differences between teaching and nonteaching US hospitals. METHODS A retrospective observational study of patients admitted to hospitals in the 2-year periods before and after the 2011 duty hour revision was conducted, utilizing a nationally representative data set. We compared patient and hospital characteristics using standardized differences. With nonteaching hospitals serving as the control group, we used multiple group interrupted time series segmented regression analysis to test for postrevision level and trend changes in mortality, length of stay (LOS), and costs. RESULTS We examined more than 117 million hospitalizations. At teaching and nonteaching hospitals, trends in mortality and LOS in prerevision and postrevision periods were not significantly different (all P > .05). A significant monthly reduction in cost per hospitalization was noted postrevision at teaching hospitals (P = .019) but not at nonteaching hospitals (P = .62). In the 2 years following the 2011 revision, there was a monthly reduction in cost per hospitalization (-$52.28; 95% confidence interval -$116.90 to -$12.32; P = .026) at teaching relative to nonteaching hospitals. CONCLUSIONS There were no differences in mortality or LOS between teaching and nonteaching hospitals. However, there was a small decrease in cost per hospitalization at teaching hospitals following the 2011 revision.
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Mendelsohn D, Despot I, Gooderham PA, Singhal A, Redekop GJ, Toyota BD. Impact of work hours and sleep on well-being and burnout for physicians-in-training: the Resident Activity Tracker Evaluation Study. MEDICAL EDUCATION 2019; 53:306-315. [PMID: 30485496 DOI: 10.1111/medu.13757] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/09/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Resident Activity Tracker Evaluation (RATE) is a prospective observational study evaluating the impact of work hours, sleep and physical activity on resident well-being, burnout and job satisfaction. BACKGROUND Physician burnout is common and its incidence is increasing. The impact of work hours and sleep on resident well-being and burnout remains elusive. Activity trackers are an innovative tool for measuring sleep and physical activity. METHODS Residents were recruited from (i) general surgery and orthopaedics (SURG), (ii) internal medicine and neurology (MED) and (iii) anaesthesia and radiology (RCD). Groups 1 and 2 do not enforce restrictions on the duration of being on-call, and group 3 had restricted the duration of being on-call to 12 hours. Participants wore FitBit trackers for 14 days. Total hours worked, daily sleep, sleep on-call and daily steps were recorded. Participants completed validated surveys assessing self-reported well-being (Short-Form Health Survey), burnout (Maslach Burnout Inventory), and satisfaction with medicine. RESULTS Surgical residents worked the most hours per week, followed by medical and RCD residents (SURG, 84.3 hours, 95% CI, 80.2-88.5; MED, 69.2 hours, 95% CI, 65.3-73.2; RCD, 52.2 hours, 95% CI, 48.2-56.1; p < 0.001). Surgical residents obtained fewer hours of sleep per day (SURG, 5.9 hours, 95% CI, 5.5-6.3; MED, 6.9 hours, 95% CI, 6.5-7.3; RCD, 6.8 hours, 95% CI, 5.6-7.2; p < 0.001). Nearly two-thirds of participants (61%) scored high burnout on the Maslach depersonalisation subscore. Total steps per day and well-being, burnout and job satisfaction were comparable between groups. Total hours worked, daily sleep and steps per day did not predict burnout or well-being. CONCLUSIONS Work hours and average daily sleep did not affect burnout. Physical activity did not prevent burnout. Work hour restrictions may lead to increased sleep but may not affect resident burnout or well-being.
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Affiliation(s)
- Daniel Mendelsohn
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivan Despot
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A Gooderham
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashtush Singhal
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary J Redekop
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian D Toyota
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Perrin DL, Cordingley DM, Leiter JR, MacDonald PB. Physical fitness of medical residents: Is the health of surgical residents at risk? Can J Surg 2018; 61:345-349. [PMID: 30247012 PMCID: PMC6153101 DOI: 10.1503/cjs.012617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/01/2022] Open
Abstract
Background Postgraduate medical residency programs are laborious and timeintensive, and can be physically, intellectually and emotionally demanding. These working conditions may lead to the neglect of personal health and well-being. The objective of this study was to compare the anthropometric and fitness characteristics of surgical and nonsurgical medical residents. We hypothesized that there is a difference in physical health between these 2 groups. Methods Medical residents completed a demographic information questionnaire and were assessed by trained staff for height, weight, body fat percentage, muscular strength and endurance, and peak oxygen consumption (V̇ᴏ2peak). The average number of working hours per week was also documented. Results Forty-five residents (21 surgical and 24 nonsurgical; 31 men and 14 women) participated in the study. Surgical residents worked more hours per week on average than nonsurgical residents (p = 0.02) and had a higher body mass index (BMI) (p = 0.04) and lower V̇ᴏ2peak (p = 0.01). Conclusion Surgical residents worked more hours than nonsurgical residents, which may have contributed to their higher BMI and lower aerobic fitness levels. Despite a heavy workload, it is important for all medical residents to find strategies to promote a healthy lifestyle for both themselves and their patients to ensure long-term well-being.
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Affiliation(s)
- David L. Perrin
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Perrin, Leiter, MacDonald) and the Pan Am Clinic Foundation, Winnipeg, Man. (Cordingley, Leiter, MacDonald)
| | - Dean M. Cordingley
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Perrin, Leiter, MacDonald) and the Pan Am Clinic Foundation, Winnipeg, Man. (Cordingley, Leiter, MacDonald)
| | - Jeff R. Leiter
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Perrin, Leiter, MacDonald) and the Pan Am Clinic Foundation, Winnipeg, Man. (Cordingley, Leiter, MacDonald)
| | - Peter B. MacDonald
- From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Perrin, Leiter, MacDonald) and the Pan Am Clinic Foundation, Winnipeg, Man. (Cordingley, Leiter, MacDonald)
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Hameed TK, Masuadi E, Al Asmary NA, Al-Anzi FG, Al Dubayee MS. A study of resident duty hours and burnout in a sample of Saudi residents. BMC MEDICAL EDUCATION 2018; 18:180. [PMID: 30071835 PMCID: PMC6090868 DOI: 10.1186/s12909-018-1300-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 07/27/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND Work hour restrictions in residency programs have been implemented over the last several decades in Europe, USA, and Canada. To best of our knowledge, there is no study of resident duty hours in the Kingdom of Saudi Arabia. In addition, few studies have looked at the prevalence of burnout amongst Saudi residents. The present study explored resident duty hours and burnout amongst residents in Saudi Arabia. METHODS A paper-based questionnaire was designed to survey resident duty hours in Saudi Arabia and was administered along with the Maslach Burnout Inventory. The questionnaires were administered to residents in medical and surgical residency programs at King Abdulaziz Medical City-Riyadh and two hospitals in Buraidah, Qassim Province. RESULTS A total of 181 residents from the three hospitals participated in the survey. In terms of average number of work hours per week, 50% of all residents reported working 60-79 h while 30% reported working 80 or more hours per week. The prevalence of burnout was 81%. There was no association between higher number of working hours and the prevalence of burnout. CONCLUSION This was the first study describing resident duty hours and exploring the relationship between duty hours and burnout in Saudi Arabia. Our main findings were that the majority of residents work 60 or more hours per week, and there was a very high degree of burnout amongst residents. A larger multi-centre study of resident duty hours and its effect on patient safety and resident well-being is needed to develop work hour regulations in Saudi Arabia. In addition, there is an urgent need to develop programs that address resident burnout.
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Affiliation(s)
- Tahir Kamal Hameed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, PO Box 22490, Riyadh, 11426 Saudi Arabia
| | - Emad Masuadi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nejoud Ali Al Asmary
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, PO Box 22490, Riyadh, 11426 Saudi Arabia
| | | | - Mohammed Saleh Al Dubayee
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, PO Box 22490, Riyadh, 11426 Saudi Arabia
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Low JM, Tan MY, See KC, Aw MM. Sleep, activity and fatigue reported by Postgraduate Year 1 residents: a prospective cohort study comparing the effects of night float versus the traditional overnight on-call system. Singapore Med J 2018; 59:652-655. [PMID: 29552687 DOI: 10.11622/smedj.2018036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION As the traditional overnight call system was shown to contribute to fatigue, Singapore implemented a shift system in 2014. We aimed to compare activity levels, sleep (using a wrist actigraph), fatigue and professional quality of life between residents working on night float and those on overnight calls. METHODS All Postgraduate Year 1 (PGY1) residents at our institution were invited to participate. Participants were required to wear a wrist actigraph for four months and complete two validated surveys (Epworth Sleepiness Scale [ESS] and Professional Quality of Life [ProQOL] scale) once each at the start and end of the study. RESULTS 49 residents were recruited. Night float and on-call residents showed a comparable median (range) number of steps (10,061 [1,195-15,923] vs. 10,649 [308-21,910]; p = 0.429), amount of sleep logged (361 [149-630] minutes vs. 380 [175-484] minutes; p = 0.369) and time taken to fall asleep (6 [0-14] minutes vs. 6 [range 0-45] minutes; p = 0.726), respectively. Night float residents had less efficient sleep, with 90.5% having sleep efficiency of over 85% compared to 100% of on-call residents (p = 0.127). More night float residents reported ESS scores > 10 (73.1% vs. 38.5%) and higher burnout scores on ProQOL scale (41.4% vs. 21.4%) at the start of the study. However, this was similar to the end of the study and not statistically significant. CONCLUSION Physical activity and amount of sleep were not significantly different between night float and on-call residents. Residents on night float reported comparatively more fatigue and burnout.
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Affiliation(s)
- Jia Ming Low
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Mae Yue Tan
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Kay Choong See
- University Medicine Cluster, National University Hospital, Singapore
| | - Marion M Aw
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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James FO, Waggoner LB, Weiss PM, Patterson PD, Higgins JS, Lang ES, Van Dongen HPA. Does Implementation of Biomathematical Models Mitigate Fatigue and Fatigue-related Risks in Emergency Medical Services Operations? A Systematic Review. PREHOSP EMERG CARE 2018; 22:69-80. [DOI: 10.1080/10903127.2017.1384875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, Kroemer AJ, Matthews ME, Curtis BR, Flickinger KL, Xun X, Bizhanova Z, Weiss PM, Condle JP, Renn ML, Sequeira DJ, Coppler PJ, Lang ES, Martin-Gill C. Shorter Versus Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical Services Personnel and Related Shift Workers: A Systematic Review. PREHOSP EMERG CARE 2018; 22:28-36. [PMID: 29324079 DOI: 10.1080/10903127.2017.1376135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study comprehensively reviewed the literature on the impact of shorter versus longer shifts on critical and important outcomes for Emergency Medical Services (EMS) personnel and related shift worker groups. METHODS Six databases (e.g., PubMed/MEDLINE) were searched, including one website. This search was guided by a research question developed by an expert panel a priori and registered with the PROSPERO database of systematic reviews (2016:CRD42016040099). The critical outcomes of interest were patient safety and personnel safety. The important outcomes of interest were personnel performance, acute fatigue, sleep and sleep quality, retention/turnover, long-term health, burnout/stress, and cost to system. Screeners worked independently and full-text articles were assessed for relevance. Data abstracted from the retained literature were categorized as favorable, unfavorable, mixed/inconclusive, or no impact toward the shorter shift duration. This research characterized the evidence as very low, low, moderate, or high quality according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS The searched yielded n = 21,674 records. Of the 480 full-text articles reviewed, 100 reported comparisons of outcomes of interest by shift duration. We identified 24 different shift duration comparisons, most commonly 8 hours versus 12 hours. No one study reported findings for all 9 outcomes. Two studies reported findings linked to both critical outcomes of patient and personnel safety, 34 reported findings for one of two critical outcomes, and 64 did not report findings for critical outcomes. Fifteen studies were grouped to compare shifts <24 hours versus shifts ≥24 hours. None of the findings for the critical outcomes of patient and personnel safety were categorized as unfavorable toward shorter duration shifts (<24 hours). Nine studies were favorable toward shifts <24 hours for at least one of the 7 important outcomes, while findings from one study were categorized as unfavorable. Evidence quality was low or very low. CONCLUSIONS The quality of existing evidence on the impact of shift duration on fatigue and fatigue-related risks is low or very low. Despite these limitations, this systematic review suggests that for outcomes considered critical or important to EMS personnel, shifts <24 hours in duration are more favorable than shifts ≥24 hours.
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Zhang Z, Krauthamer AV, Rosenkrantz AB. The Media Response to the ACGME's 2017 Relaxed Resident Duty-Hour Restrictions. J Am Coll Radiol 2017; 15:452-457. [PMID: 29290595 DOI: 10.1016/j.jacr.2017.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE In March 2017, the ACGME relaxed resident duty-hour restrictions to allow first-year residents to work 24-hour shifts, affecting the internship experience of incoming radiology residents. The aim of this study was to assess the media response to this duty-hour change, comparing news articles with favorable and unfavorable views. METHODS Google News was used to identify 36 relevant unique news articles published over a 4-week period after the announcement. Articles' stance was categorized as favorable, unfavorable, or neutral. Additional article characteristics were explored. RESULTS Article sources were 58% national, 22% local, and 20% medical news. Article stance was most commonly unfavorable for national news sources (48%), compared with neutral for local (62%) and medical (72%) news sources. Most common reasons for unfavorable stance were sleep deprivation (n = 11), medical errors (n = 11), residents' health (n = 9), risk for car accidents (n = 9), a patriarchal hazing system (n = 6), and work-life balance (n = 5). Most common reasons for favorable stance were impact on resident education (n = 7) and continuity of care (n = 7). Supporting data were cited by 38% of unfavorable and 100% of favorable articles. Unfavorable articles most commonly quoted physicians affiliated with resident advocacy groups; favorable articles most commonly quoted physicians affiliated with the ACGME. CONCLUSIONS The relaxed duty-hour restrictions received an overall unfavorable media response, particularly in nonmedical news sources, driven by concerns regarding sleep-deprived doctors. Favorable articles ubiquitously cited data supporting the safety of relaxed duty hour restrictions. Further research is warranted to better understand the impact of relaxed resident duty-hour limits on sleep deprivation, residents' health and education, and the quality of patient care.
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Affiliation(s)
- Zi Zhang
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, New York.
| | - Alan V Krauthamer
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, New York
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Burchiel KJ, Zetterman RK, Ludmerer KM, Philibert I, Brigham TP, Malloy K, Arrighi JA, Ashley SW, Bienstock JL, Carek PJ, Correa R, Forstein DA, Gaiser RR, Gold JP, Keepers GA, Kennedy BC, Kirk LM, Kothari A, Langdale LA, Shayne PH, Stain SC, Woods SK, Wyatt-Johnson C, Nasca TJ. The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment. J Grad Med Educ 2017; 9:692-696. [PMID: 29270256 PMCID: PMC5734321 DOI: 10.4300/jgme-d-17-00317.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Krug MF, Golob AL, Wander PL, Wipf JE. Changes in Resident Well-Being at One Institution Across a Decade of Progressive Work Hours Limitations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1480-1484. [PMID: 28353505 PMCID: PMC5617767 DOI: 10.1097/acm.0000000000001675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To measure changes in markers of resident well-being over time as progressive work hours limitations (WHLs) were enforced, and to investigate resident perceptions of the 2011 WHLs. METHOD A survey study of internal medicine residents was conducted at the University of Washington's multihospital residency program in 2012. The survey included validated well-being questions: the Maslach Burnout Inventory, the two-question PRIME-MD depression screen, and career satisfaction questions. Chi-square tests were used to compare 2012 well-being questionnaire responses against nearly identical surveys conducted in 2001 and 2004 at the same institution. In addition, residents were asked to rate the impact of WHLs on resident well-being and education as well as patient care, and to state preferences for future WHLs. RESULTS Significantly different proportions of residents met burnout criteria across time, with fewer meeting criteria in 2012 than in 2001 (2001: 76% [87/115]; 2004: 64% [75/118]; 2012: 61% [68/112]; P = .039). Depression screening results also differed across time, with fewer screening positive in 2012 than in 2004 (2001: 45% [52/115]; 2004: 55% [65/118]; 2012 [35/112]: 31%; P = .001). Residents, especially seniors, reported perceived negative impacts of WHLs on their well-being, education, and patient care. Most senior residents favored reverting to the pre-July 2011 system of WHLs. Interns were more divided. CONCLUSIONS Validated measures of resident well-being changed across the three time points measured. Residents had the lowest rates of burnout and depression in 2012. Resident perceptions of the 2011 WHLs, however, were generally negative.
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Affiliation(s)
- Michael F Krug
- M.F. Krug is clinical assistant professor, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington. A.L. Golob is acting assistant professor, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, and attending physician, VA Puget Sound Healthcare System, Seattle, Washington. P.L. Wander is acting instructor, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, and attending physician, VA Puget Sound Healthcare System, Seattle, Washington. J.E. Wipf is professor, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, and section head of General Internal Medicine, VA Puget Sound Healthcare System, Seattle, Washington
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McKinley TF, Boland KA, Mahan JD. Burnout and interventions in pediatric residency: A literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.burn.2017.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bilimoria KY, Quinn CM, Dahlke AR, Kelz RR, Shea JA, Rajaram R, Love R, Kreutzer L, Biester T, Yang AD, Hoyt DB, Lewis FR. Use and Underlying Reasons for Duty Hour Flexibility in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. J Am Coll Surg 2017; 224:118-125. [DOI: 10.1016/j.jamcollsurg.2016.10.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 01/11/2023]
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Kreutzer L, Dahlke AR, Love R, Ban KA, Yang AD, Bilimoria KY, Johnson JK. Exploring Qualitative Perspectives on Surgical Resident Training, Well-Being, and Patient Care. J Am Coll Surg 2017; 224:149-159. [DOI: 10.1016/j.jamcollsurg.2016.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Counselman FL, Kowalenko T, Marco CA, Joldersma KB, Korte RC, Reisdorff EJ. The Relationship Between ACGME Duty Hour Requirements and Performance on the American Board of Emergency Medicine Qualifying Examination. J Grad Med Educ 2016; 8:558-562. [PMID: 27777667 PMCID: PMC5058589 DOI: 10.4300/jgme-d-15-00591.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted requirements that limited the number of hours residents could spend on duty, and in 2011, it revised these requirements. OBJECTIVE This study explored whether the implementation of the 2003 and 2011 duty hour limits was associated with a change in emergency medicine residents' performance on the American Board of Emergency Medicine (ABEM) Qualifying Examination (QE). METHODS Beginning with the 1999 QE and ending with the 2014 QE, candidates for whom all training occurred without duty hour requirements (Group A), candidates under the first set of duty hour requirements (Group C), and candidates under the second set of duty hour requirements (Group E) were compared. Comparisons included mean scores and pass rates. RESULTS In Group A, 5690 candidates completed the examination, with a mean score of 82.8 and a 90.2% pass rate. In Group C, 8333 candidates had a mean score of 82.4 and a 90.5% pass rate. In Group E, there were 1269 candidates, with a mean score of 82.5 and an 89.4% pass rate. There was a small but statistically significant decrease in the mean scores (0.04, P < .001) after implementation of the first duty hour requirements, but this difference did not occur after implementation of the 2011 standards. There was no difference among pass rates for any of the study groups (χ2 = 1.68, P = .43). CONCLUSIONS We did not identify an association between the 2003 and 2011 ACGME duty hour requirements and performance of test takers on the ABEM QE.
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Affiliation(s)
- Francis L. Counselman
- Corresponding author: Francis L. Counselman, MD, Eastern Virginia Medical School, Raleigh Building, Room 304, 600 Gresham Drive, Norfolk, VA 23507, 757.388.3397,
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Ouyang D, Chen JH, Krishnan G, Hom J, Witteles R, Chi J. Patient Outcomes when Housestaff Exceed 80 Hours per Week. Am J Med 2016; 129:993-999.e1. [PMID: 27103047 PMCID: PMC4996740 DOI: 10.1016/j.amjmed.2016.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigated whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work more than 80 hours per week. METHODS We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether the patient was admitted by housestaff who have worked more than 80 hours per week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, intensive care unit (ICU) transfer rate, and 30-day readmission rate. RESULTS We identified 4767 hospitalizations by 3450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than 80 hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs 16.7%, P = .031) for patients admitted by housestaff working more than 80 hours per week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs 4.66 days, P = .048) and rate of ICU transfer (3.53% vs 2.38%, P = .029). There was no statistically significant difference in 30-day readmission rate (13.7% vs 12.8%, P = .395) or in-hospital mortality rate (3.18% vs 2.42%, P = .115). There was no correlation with team census on admission and patient outcomes. CONCLUSIONS Patients taken care of by housestaff working more than 80 hours per week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.
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Affiliation(s)
- David Ouyang
- Department of Internal Medicine, Stanford University School of Medicine, Calif
| | - Jonathan H Chen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Calif
| | - Gomathi Krishnan
- Stanford Center for Clinical Informatics, Stanford University School of Medicine, Calif
| | - Jason Hom
- Department of Internal Medicine, Stanford University School of Medicine, Calif
| | - Ronald Witteles
- Department of Internal Medicine, Stanford University School of Medicine, Calif
| | - Jeffrey Chi
- Department of Internal Medicine, Stanford University School of Medicine, Calif.
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Bega D, Krainc D. Challenges to neurology residency education in today's health care environment. Ann Neurol 2016; 80:315-20. [DOI: 10.1002/ana.24729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/04/2016] [Accepted: 07/10/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Danny Bega
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicago IL
| | - Dimitri Krainc
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicago IL
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Mullen MG, Salerno EP, Michaels AD, Hedrick TL, Sohn MW, Smith PW, Schirmer BD, Friel CM. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery? JOURNAL OF SURGICAL EDUCATION 2016; 73:609-615. [PMID: 27066854 PMCID: PMC4985608 DOI: 10.1016/j.jsurg.2016.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. METHODS A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. RESULTS A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). CONCLUSIONS Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education.
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Affiliation(s)
- Matthew G Mullen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Elise P Salerno
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex D Michaels
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Min-Woong Sohn
- Department of Public Health Sciences, Health System Old Medical School, University of Virginia, Charlottesville, Virginia
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Fletcher KE, Ranji SR. Does it matter how much physician trainees work anymore? BMJ Qual Saf 2016; 25:914-916. [PMID: 27118871 DOI: 10.1136/bmjqs-2016-005534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Kathlyn E Fletcher
- Department of Internal Medicine, Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA.,Department of Internal Medicine, Medical College of Wisconsin, Wisconsin, USA
| | - Sumant R Ranji
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
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Vukkadala N, Auerbach A, Maselli JH, Rosenbluth G. Association between ordering patterns and shift-based care in general pediatrics inpatients. J Hosp Med 2016; 11:210-4. [PMID: 26559789 DOI: 10.1002/jhm.2507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 09/19/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022]
Abstract
Duty-hour restrictions have forced changes in care models for inpatient services, including an increase in shift work. In this study we aimed to determine whether a shift model compliant with 2011 Accreditation Council for Graduate Medical Education duty-hour standards was associated with more active patient care management. Residents caring for pediatric patients changed from a schedule with extended duty shifts and cross-coverage to one based on day/night shifts, limiting interns to 16 consecutive duty hours. We conducted a retrospective review of orders written under each model. After the intervention, there was a significant increase in the mean number of orders written within the first 12 hours (pre: 0.58 orders vs post: 1.12, P = 0.009) and 24 hours (pre: 1.52 vs post: 2.38, P = 0.004) following admission (not including admission orders), but we did not detect a significantly higher percentage of orders written at night. This shift-based coverage system was associated with a greater number of orders written early in the hospitalization, indicating more active management of clinical problems.
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Affiliation(s)
- Neelaysh Vukkadala
- University of California, San Francisco, School of Medicine, San Francisco, California
| | - Andrew Auerbach
- Division of Hospital Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Judith H Maselli
- Division of Hospital Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Glenn Rosenbluth
- Division of Pediatric Hospital Medicine, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
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Affiliation(s)
- Eric J. Warm
- Corresponding author: Eric J. Warm, MD, University of Cincinnati Academic Health Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0557, 513.558.1976, fax 513.558.3878,
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Lin H, Lin E, Auditore S, Fanning J. A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:140-50. [PMID: 26445081 DOI: 10.1097/acm.0000000000000937] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. METHOD The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. RESULTS A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. CONCLUSIONS The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.
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Affiliation(s)
- Henry Lin
- H. Lin is a pediatric gastroenterologist, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. E. Lin is a gastroenterology fellow, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. S. Auditore is market segment development manager, American Medical Association, Chicago, Illinois. J. Fanning is chief of membership and resident fellow member-early career psychiatrist officer, American Psychiatric Association, Arlington, Virginia
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Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. MEDICAL EDUCATION 2016; 50:132-49. [PMID: 26695473 DOI: 10.1111/medu.12927] [Citation(s) in RCA: 540] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 09/03/2015] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To summarise articles reporting on burnout among medical students and residents (trainees) in a narrative review. METHODS MEDLINE was searched for peer-reviewed, English language articles published between 1990 and 2015 reporting on burnout among trainees. The search used combinations of Medical Subject Heading terms medical student, resident, internship and residency, and burnout, professional. Reference lists of articles were reviewed to identify additional studies. A subset of high-quality studies was selected. RESULTS Studies suggest a high prevalence of burnout among trainees, with levels higher than in the general population. Burnout can undermine trainees' professional development, place patients at risk, and contribute to a variety of personal consequences, including suicidal ideation. Factors within the learning and work environment, rather than individual attributes, are the major drivers of burnout. Limited data are available regarding how to best address trainee burnout, but multi-pronged efforts, with attention to culture, the learning and work environment and individual behaviours, are needed to promote trainees' wellness and to help those in distress. CONCLUSION Medical training is a stressful time. Large, prospective studies are needed to identify cause-effect relationships and the best approaches for improving the trainee experience.
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Affiliation(s)
- Liselotte Dyrbye
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tait Shanafelt
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Scally CP, Ryan AM, Thumma JR, Gauger PG, Dimick JB. Early impact of the 2011 ACGME duty hour regulations on surgical outcomes. Surgery 2015; 158:1453-61. [PMID: 26054323 PMCID: PMC4637214 DOI: 10.1016/j.surg.2015.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/20/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. Although the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood. METHODS We used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009-June, 2011) and the 18 months thereafter (July, 2011-December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using nonteaching hospitals as a control group, to compare risk-adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes. RESULTS After duty hour reform, no changes were seen in the measured outcomes when comparing teaching with nonteaching hospitals. Even when stratifying by teaching intensity, there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio of ≥ 0.6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared with 4.7% and 4.4% for nonteaching hospitals (relative risk [RR], 0.98; 95% CI, 0.89-1.07). Similarly, serious complication (RR, 1.02; 95% CI, 0.98-1.06), FTR (RR, 0.95; 95% CI, 0.87-1.04), and readmission (odds ratio, 1.00; 95% CI, 0.96-1.03) rates were unchanged. CONCLUSION In Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations.
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Affiliation(s)
- Christopher P Scally
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI; General Surgery Residency Program, Department of Surgery, University of Michigan, Ann Arbor, MI.
| | - Andrew M Ryan
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jyothi R Thumma
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Paul G Gauger
- General Surgery Residency Program, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI
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Scally CP, Sandhu G, Magas C, Gauger PG, Minter RM. Investigating the Impact of the 2011 ACGME Resident Duty Hour Regulations on Surgical Residency Programs: The Program Director Perspective. J Am Coll Surg 2015; 221:883-9.e1. [PMID: 26272015 PMCID: PMC4569491 DOI: 10.1016/j.jamcollsurg.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/01/2015] [Accepted: 07/08/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 2011 ACGME regulations required substantial changes to the structure of general surgery residency programs, due primarily to the 16-hour in-house rule for PGY1 residents. However, the scope of changes that programs have undertaken to meet these requirements, and the educational impact of those changes, are poorly understood. STUDY DESIGN We performed in-depth qualitative interviews with general surgery program directors. Twenty program directors participated in the study; interviews were conducted until adequate thematic saturation was achieved. Participants were recruited from a stratified random sampling of residency programs in the United States to ensure a representative cohort. Interviews focused on changes in call schedule, interns' educational requirements, development, and satisfaction. RESULTS Most programs used a month-long night float (NF) rotation (14 of 20 [75%]). A minority of programs (5 of 20 [25%]) used a weekly rotating schedule, in which interns worked 5 to 6 nights in a month. Multiple programs (65%) had an NF in place before 2011; these programs made changes to and expanded their existing schedule to accommodate the new regulations. Commonly cited challenges to instituting NF included weekend coverage (60%) and providing adequate days off during day-to-night transition. Interns spent as much as 3 months of the year on NF. Only 5 programs made explicit changes to teaching schedules or developed a curriculum for residents on NF. Seventy-five percent of programs excused interns, explicitly or implicitly, from didactic teaching when on NF. Common themes noted by program directors included delayed maturation of trainees, interns being isolated from the team culture, and a conflict between the professional behaviors of "following the rules" and "doing what is right."
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Affiliation(s)
- Christopher P Scally
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | | | - Paul G Gauger
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Rebecca M Minter
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
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Bolster L, Rourke L. The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review. J Grad Med Educ 2015; 7:349-63. [PMID: 26457139 PMCID: PMC4597944 DOI: 10.4300/jgme-d-14-00612.1] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite 25 years of implementation and a sizable amount of research, the impact of resident duty hour restrictions on patients and residents still is unclear. Advocates interpret the research as necessitating immediate change; opponents draw competing conclusions. OBJECTIVE This study updates a systematic review of the literature on duty hour restrictions conducted 1 year prior to the implementation of the Accreditation Council for Graduate Medical Education's 2011 regulations. METHODS The review draws on reports catalogued in MEDLINE and PreMEDLINE from 2010 to 2013. Interventions that dealt with the duty hour restrictions included night float, shortened shifts, and protected time for sleep. Outcomes were patient care, resident well-being, and resident education. Studies were excluded if they were not conducted in patient care settings. RESULTS Twenty-seven studies met the inclusion criteria. Most frequently, the studies concluded that the restrictions had no impact on patient care (50%) or resident wellness (47%), and had a negative impact on resident education (64%). Night float was the most frequent means of implementing duty hour restrictions, yet it yielded the highest proportion of unfavorable findings. CONCLUSIONS This updated review, including 27 recent applicable studies, demonstrates that focusing on duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education. New approaches to the issue of physician fatigue and its relationship to patient care and resident education are needed.
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Affiliation(s)
- Lauren Bolster
- Corresponding author: Lauren Bolster, MD, University of Alberta, Department of Medicine, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB T6G 2P4 Canada, 780.407.1584,
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Cook DA, Reed DA. Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1067-76. [PMID: 26107881 DOI: 10.1097/acm.0000000000000786] [Citation(s) in RCA: 436] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale-Education (NOS-E) were developed to appraise methodological quality in medical education research. The study objective was to evaluate the interrater reliability, normative scores, and between-instrument correlation for these two instruments. METHOD In 2014, the authors searched PubMed and Google for articles using the MERSQI or NOS-E. They obtained or extracted data for interrater reliability-using the intraclass correlation coefficient (ICC)-and normative scores. They calculated between-scale correlation using Spearman rho. RESULTS Each instrument contains items concerning sampling, controlling for confounders, and integrity of outcomes. Interrater reliability for overall scores ranged from 0.68 to 0.95. Interrater reliability was "substantial" or better (ICC > 0.60) for nearly all domain-specific items on both instruments. Most instances of low interrater reliability were associated with restriction of range, and raw agreement was usually good. Across 26 studies evaluating published research, the median overall MERSQI score was 11.3 (range 8.9-15.1, of possible 18). Across six studies, the median overall NOS-E score was 3.22 (range 2.08-3.82, of possible 6). Overall MERSQI and NOS-E scores correlated reasonably well (rho 0.49-0.72). CONCLUSIONS The MERSQI and NOS-E are useful, reliable, complementary tools for appraising methodological quality of medical education research. Interpretation and use of their scores should focus on item-specific codes rather than overall scores. Normative scores should be used for relative rather than absolute judgments because different research questions require different study designs.
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Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, Department of Medicine; associate director, Mayo Center for Online Learning; and research chair, Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic College of Medicine, Rochester, Minnesota. D.A. Reed is associate professor of medicine and medical education, Department of Medicine, and senior associate dean of academic affairs, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota
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50
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Brown SES, Ratcliffe SJ, Halpern SD. Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms. Chest 2015; 147:626-636. [PMID: 25393027 DOI: 10.1378/chest.14-1060] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND ICU readmissions are associated with increased mortality and costs; however, it is unclear whether these outcomes are caused by readmissions or by residual confounding by illness severity. An assessment of temporal changes in ICU readmission in response to a specific policy change could help disentangle these possibilities. We sought to determine whether ICU readmission rates changed after 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform ("reform") and whether there were temporally corresponding changes in other ICU outcomes. METHODS We used a difference-in-differences approach using Project IMPACT (Improved Methods of Patient Information Access of Core Clinical Tasks). Piecewise regression models estimated changes in outcomes immediately before and after reform in 274,491 critically ill medical and surgical patients in 151 community and academic US ICUs. Outcome measures included ICU readmission, ICU mortality, and in-hospital post-ICU-discharge mortality. RESULTS In ICUs with residents, ICU readmissions increased before reform (OR, 1.5; 95% CI, 1.22-1.84; P < .01), and decreased after (OR, 0.85; 95% CI, 0.73-0.98; P = .03). This abrupt decline in ICU readmissions after reform differed significantly from an increase in readmissions observed in ICUs without residents at this time (difference-in-differences P < .01). No comparable changes in mortality were observed between ICUs with vs without residents. CONCLUSIONS The changes in ICU readmission rates after reform, without corresponding changes in mortality, suggest that ICU readmissions are not causally related to other untoward patient outcomes. Instead, ICU readmission rates likely reflect operational aspects of care that are not patient-centered, making them less useful indicators of ICU quality.
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Affiliation(s)
- Sydney E S Brown
- Center for Clinical Epidemiology and Biostatistics and Division of Pulmonary, Department of Anesthesiology and Critical Care, University of Pennsylvania.
| | - Sarah J Ratcliffe
- Center for Clinical Epidemiology and Biostatistics and Division of Pulmonary
| | - Scott D Halpern
- Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Center for Bioethics, Philadelphia, PA
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