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Karampouga M, Karagianni M, Mihaylova S, Aydin AE, Salokorpi N, Lambrianou X, Tsianaka E, Janssen IK, Duran SH, Ivan DL, Rodríguez-Hernandez A, Broekman ML, Gazioglu N, Tasiou A, Murphy M. Caffeine, Alcohol, and Drug Use as Work Adjuncts Among Neurosurgeons. Prevalence, Contributing Factors, and Proposed Strategies. World Neurosurg 2024:S1878-8750(24)01289-0. [PMID: 39069131 DOI: 10.1016/j.wneu.2024.07.150] [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: 05/26/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Neurosurgeons may resort to caffeine, alcohol, and various drugs to maintain peak performance as they grapple with work demands and escalated stress. The prevalence of this controversial strategy remains largely unexplored. METHODS An anonymous survey of 23 questions formulated by our research group was distributed through personal contacts and neurosurgical societies. Inquiries revolved around the use of medications and other substances for job-related reasons. Data were analyzed via regression and descriptive statistics in python. RESULTS In total, 215 neurosurgeons (43 residents) were included, with 213 disclosing their gender (94 females). Out of all, 9.3% were <30, 38.1% were 30-39, 44.6% were 40-59, and 7.9% were >60 years old. Most (70.7%) practiced in Europe, 18.6% in Asia, 6.5% in North and South America, and the rest in Africa or Australia. While 132 participants stated they consume caffeine to manage challenging schedules, drugs for cognitive and mood enhancement were utilized by 18 and 35 respectively. Alcohol was employed for stress relief by 28 with 4 reporting as heavy drinkers. Drugs posed a solution to sleep disorders for 82, and helped 8 others in strengthening their hand dexterity. Notably, 12 of those claiming drug use initiated it in medical school. Exercise, self-care activities, and relational support were the main alternatives sought. Ultimately, most responders recommended extending mental health assistance and raising awareness about drug use. CONCLUSIONS Reflecting on our results on job-associated drug use by neurosurgeons, we propose the judicious use of pharmacological or nonpharmacological adjuncts, alongside the prioritization of neurosurgeons' well-being.
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Affiliation(s)
- Maria Karampouga
- Department of Neurological Surgery, Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Nicosia General Hospital, Nicosia, Cyprus.
| | - Maria Karagianni
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
| | - Stiliana Mihaylova
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Aysegul Esen Aydin
- Department of Neurosurgery, Arnavutkoy State Hospital, Istanbul, Türkiye
| | - Niina Salokorpi
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland, and Research Unit of Clinical Neuroscience, Medical Research Center, Oulu University, Oulu, Finland
| | | | - Eleni Tsianaka
- Neurosurgery Department, International Hospital, Salmiya, Kuwait
| | - Insa K Janssen
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Daniela Luminita Ivan
- Department of Neurosurgery, Bucharest Emergency University Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Ana Rodríguez-Hernandez
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Universidad Autónoma, Barcelona, Spain
| | - Marike Ld Broekman
- Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden, The Netherlands
| | - Nurperi Gazioglu
- Medical Faculty, Department of Neurosurgery, Istinye University, Istanbul, Türkiye
| | - Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
| | - Mary Murphy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Flink CC, Hobohm RE, Zhang B, Jacobson DL, England EB. Effects of night-float shifts on cognitive function among radiology residents. Emerg Radiol 2024:10.1007/s10140-024-02269-3. [PMID: 39046634 DOI: 10.1007/s10140-024-02269-3] [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: 04/16/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Many radiology programs utilize a night-float system to mitigate the effects of fatigue, improve patient care, and provide faster report turnaround times. Prior studies have demonstrated an increase in discrepancy rates during night-float shifts. OBJECTIVES This study was performed to examine the effects of night-float shift work on radiology resident cognition. We hypothesized that there would be diminished cognitive function on testing following night-float shifts when compared to testing following day shifts. METHODS Diagnostic radiology residents in their second to fifth years of residency at a single institution were recruited to participate in this pilot study. Cognitive function was evaluated using the Lumosity Neurocognitive Performance Tests (NCPT), standardized performance tests that provide real-time, objective measurements of cognitive function. Study participants completed the NCPT in 5 sessions following 5 consecutive day shifts to evaluate their baseline cognitive function. The tests were re-administered at the end of consecutive night-float shifts to assess for any changes. Sleep was objectively monitored using actigraphy devices worn around the wrist during all study weeks. Descriptive and summary statistics were performed. RESULTS 23 prospectively recruited diagnostic radiology residents working night-float shifts took a mean 13.6 (± 5.1) neurocognitive performance tests during the study period. There was a statistically significant decline in 2 of the 6 cognitive tests administered, signifying a decrease in attention, speed, and complex reasoning ability. Night-float shifts were significantly longer than the day shifts and associated with a significantly higher study volume and cross-sectional study volume. Fitbit data demonstrated that there were no significant differences in level of activity while awake. However, participants slept significantly longer during day shifts. CONCLUSIONS A sample of 23 radiology residents working night-float shifts demonstrated declines in attention, speed, and complex reasoning ability following sequential administration of standardized neurocognitive performance tests. While the sample size is small, these findings demonstrate the potential deleterious effects of night-float shift work and provide evidence to support further inquiry into this phenomenon.
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Affiliation(s)
- Carl C Flink
- Department of Radiology, University of Cincinnati Medical Center, CARE/Crawley Building, Suite E-870, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
| | - Robert E Hobohm
- Department of Radiology, University of Cincinnati Medical Center, CARE/Crawley Building, Suite E-870, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deborah L Jacobson
- Division of Urology, Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Eric B England
- Department of Radiology, University of Cincinnati Medical Center, CARE/Crawley Building, Suite E-870, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
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Mul Fedele ML, López Gabeiras MDP, Simonelli G, Diez JJ, Bellone GJ, Cagliani J, Larrateguy L, Eiguchi K, Golombek DA, Cardinali DP, Pérez-Chada D, Vigo DE. "Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach". BMC Public Health 2023; 23:2317. [PMID: 37996804 PMCID: PMC10666331 DOI: 10.1186/s12889-023-17130-4] [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: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
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Affiliation(s)
- Malena Lis Mul Fedele
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina
| | | | - Guido Simonelli
- Centre d'études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de L'Île-de-Montréal, Montreal, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Joaquín José Diez
- Pan-American Institute of Sleep Medicine and Chronobiology, Buenos Aires, Argentina
| | - Giannina Julieta Bellone
- Pontifical Catholic University of Argentina, Buenos Aires, Argentina
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
| | - Joaquín Cagliani
- Anesthesiology Department, North Shore University Hospital, Manhasset, NY, USA
| | - Luis Larrateguy
- Private Center of Respiratory Medicine of Paraná, Entre Ríos, Argentina
| | | | - Diego Andrés Golombek
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
- Interdisciplinary Time Lab, San Andrés University, Buenos Aires, Argentina
| | | | | | - Daniel Eduardo Vigo
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina.
- Katholieke Universiteit Leuven, Leuven, Belgium.
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Weaver MD, Sullivan JP, Landrigan CP, Barger LK. Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk. Jt Comm J Qual Patient Saf 2023; 49:634-647. [PMID: 37543449 DOI: 10.1016/j.jcjq.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
Resident physician work hour limits continue to be controversial. Numerous trials have come to conflicting conclusions about the impact on patient safety of eliminating extended duration work shifts. We conducted meta-analyses to evaluate the impact of work hour policies and work schedules on patient safety. After identifying 8,362 potentially relevant studies and reviewing 688 full-text articles, 132 studies were retained and graded on quality of evidence. Of these, 68 studies provided enough information for consideration in meta-analyses. We found that patient safety improved following implementation of the Accreditation Council for Graduate Medical Education's 2003 and 2011 resident physicians work hour guidelines. Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes. Given the preponderance of evidence showing that patient and physician safety is negatively affected by long work hours, efforts to improve physician schedules should be prioritized. Policies that enable extended-duration shifts and long work weeks should be reexamined. Further research should expand beyond resident physicians to additional study populations, including attending physicians and other health care workers.
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Maoz Breuer R, Waitzberg R, Breuer A, Cram P, Bryndova L, Williams GA, Kasekamp K, Keskimaki I, Tynkkynen LK, van Ginneken V, Kovács E, Burke S, McGlacken-Byrne D, Norton C, Whiston B, Behmane D, Grike I, Batenburg R, Albreh T, Pribakovic R, Bernal-Delgado E, Estupiñan-Romero F, Angulo-Pueyo E, Rose AJ. Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries. Health Policy 2023; 130:104753. [PMID: 36827717 DOI: 10.1016/j.healthpol.2023.104753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
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Affiliation(s)
- Rina Maoz Breuer
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Cram
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Lucie Bryndova
- Center for Social and Economic Strategies, Faculty of Social Sciences, Charles University, Czechia
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London United Kingdom
| | | | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Finland
| | - Verena van Ginneken
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin, Germany
| | - Eszter Kovács
- Health Workforce Planning Knowledge Centre, Semmelweis University, Hungary
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | | | | | | | - Daiga Behmane
- Faculty of Public Health and Social Welfare, Riga Stradins University, Latvia
| | - Ieva Grike
- Faculty of Residency Manager of Residency study process Riga Stradins University, Latvia
| | - Ronald Batenburg
- Netherlands institute for Health Services Research (Nivel), Radboud University Nijmegen, Faculty of Social Sciences, the Netherlands
| | - Tit Albreh
- Centre for Health Care National Institute of Public Health Trubarjeva, Slovenia
| | - Rade Pribakovic
- Centre for Health Care at the National Institute of Public Health of Slovenia, Slovenia
| | | | | | | | - Adam J Rose
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; School of Public Health, Hebrew University, Jerusalem, Israel
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Real Noval H, Martin Parra JI, Fernández Fernández J, Del Castillo Criado Á, Ruiz Gómez JL, López Useros A, Fernández Santiago R, Manuel Palazuelos JC. Sleep deprivation among surgical residents: Does it affect performance while practising a laparoscopic intestinal anastomosis? Cir Esp 2022; 100:223-228. [PMID: 35431159 DOI: 10.1016/j.cireng.2022.03.014] [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: 10/12/2020] [Accepted: 12/03/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the FATIGUE group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the REST group(R), being those who slept at home for more than 7 h. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33.5% anastomoses, as opposed to 19.4% in the rest group (P < .01). El rest group performed the anastomosis in 56.75 min and the fatigue group in 61,49 min (P = .006). There were no significant differences in the others parameters. CONCLUSIONS Fatigue increases the risk of leakage and the time to do the exercise.
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Affiliation(s)
- Héctor Real Noval
- Servicio de Cirugía General, Hopistal de Jarrio, Coaña, Asturias, Spain.
| | - José Ignacio Martin Parra
- Servicio de Cirugía General, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain; Hospital virtual Valdecilla, Santander, Cantabria, Spain
| | | | | | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, Cantabria, Spain; Servicio de Cirugía General, Hospital Sierrallana, Torrelavega, Cantabria, Spain
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain; Hospital virtual Valdecilla, Santander, Cantabria, Spain
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain; Hospital virtual Valdecilla, Santander, Cantabria, Spain
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain; Hospital virtual Valdecilla, Santander, Cantabria, Spain
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Kelly-Schuette K, Shaker T, Carroll J, Davis AT, Wright GP, Chung M. A Prospective Observational Study Comparing Effects of Call Schedules on Surgical Resident Sleep and Physical Activity Using the Fitbit. J Grad Med Educ 2021; 13:113-118. [PMID: 33680310 PMCID: PMC7901626 DOI: 10.4300/jgme-d-20-00304.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/02/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Surgical residency training has an extended tradition of long hours. Residency programs use a variety of call schedules to combat resident fatigue and sleep deprivation while maintaining adherence to duty hour restrictions. Nonetheless, there is a paucity of data regarding objective measurements of sleep during the different call schedules included in general surgery training. OBJECTIVE The primary objective of this study was to compare the quantity of sleep in 24-hour time frames across all types of shifts worked by general surgery residents at our institution. The secondary objective was to measure activity level in total steps during various time frames. METHODS This prospective observational study was performed between April 4 and August 26, 2018, with general surgery residents. Each resident was assigned a Fitbit Charge 2 to wear during all rotations, including general surgery and subspecialty services. RESULTS Twenty-six out of 31 residents voluntarily participated in the study (84%). In-house call (IHC) had significantly less sleep in a 24-hour time frame than home call and night float (144 vs 283 vs 246 minutes, P < .001 and P < .028). IHC had significantly more steps than home call (11 245 vs 8756 steps, P = .039). The smallest number of steps was obtained when residents were not working (7904 steps). CONCLUSIONS Our data demonstrate that surgical residents on IHC have significantly less sleep compared to all other types of on-call time frames. Residents on IHC have the most steps across all time frames.
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Real Noval H, Martín Parra JI, Fernández Fernández J, Del Castillo Criado Á, Ruiz Gómez JL, López Useros A, Fernández Santiago R, Manuel Palazuelos JC. Sleep deprivation among surgical residents: does it affect performance while practising a laparoscopic intestinal anastomosis? Cir Esp 2021; 100:S0009-739X(20)30406-1. [PMID: 33468360 DOI: 10.1016/j.ciresp.2020.12.010] [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: 10/12/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the fatigue group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the rest group (R), being those who slept at home for more than 7 hours. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33,5% anastomoses, as opposed to 19,4% in the rest group (p < 0.01). El rest group performed the anastomosis in 56,75 min and the fatigue group in 61,49 min (p = 0.006). There were no significant differences in the others parameters. CONCLUSIONS Fatigue increases the risk of leakage and the time to do the exercise.
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Affiliation(s)
- Héctor Real Noval
- Servicio de Cirugía General, Hospital de Jarrio, Coaña, Asturias, España.
| | - José Ignacio Martín Parra
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Hospital virtual Valdecilla, Santander, Cantabria, España
| | | | | | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, Cantabria, España; Servicio de Cirugía General, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Hospital virtual Valdecilla, Santander, Cantabria, España
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Hospital virtual Valdecilla, Santander, Cantabria, España
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Hospital virtual Valdecilla, Santander, Cantabria, España
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Whelehan DF, Alexander M, Ridgway PF. Would you allow a sleepy surgeon operate on you? A narrative review. Sleep Med Rev 2020; 53:101341. [DOI: 10.1016/j.smrv.2020.101341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/22/2023]
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Guan X, Ni B, Zhang J, Man C, Cai Z, Meng W, Shi L, Ross-Degnan D. The Impact of Physicians' Working Hours on Inappropriate Use of Outpatient Medicine in a Tertiary Hospital in China. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:443-451. [PMID: 31879829 DOI: 10.1007/s40258-019-00544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Inappropriate prescribing is an important health system problem in China. Several studies have identified critical factors influencing prescription quality, but the impact of physicians' working hours remains unknown. In China, tertiary hospitals face ever-increasing outpatient volumes. Physicians are asked to work long hours and the impact of shift duration on prescription quality is unknown. OBJECTIVE We aimed to investigate the association between consecutive working hours and the quality of physicians' prescriptions in a Chinese tertiary hospital. METHODS We obtained all outpatient electronic health records from the hospital information system (HIS) of a tertiary hospital in Beijing, China from 1 July to 30 November 2015. Prescriptions made during two periods were analyzed: a morning shift from 7:30 to 12:30, and an afternoon shift from 13:30 to 18:30. The time when a physician issued the first prescription was considered the beginning of the work shift and prescriptions within the next 4 consecutive hours were included. Potentially inappropriate prescriptions were based on the Rational Drug Use (RDU) system that was developed and validated for this study. We used multivariable logistic regression to examine the impact of shift duration and other clinical and physician factors on potentially inappropriate prescribing. RESULTS Of the total 560,529 prescriptions, 15.3% were classified as inappropriate by the RDU system. Physicians' inappropriate prescribing increased in the last hour in each work shift (odds ratio (OR) for the fourth hour compared to the first = 1.12 (95% CI, 1.09-1.15)). We also found that physicians who worked all day had a higher rate of inappropriate prescribing than those who only worked half a day (OR = 1.05 (95% CI, 1.04-1.07)). CONCLUSIONS Longer working hours are a risk factor for inappropriate prescribing. Relevant interventions are urgently needed to establish working hour limits in China to reduce the likelihood of inappropriate prescribing by physicians.
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Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Bingyu Ni
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Jingyuan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Chunxia Man
- Aerospace Center Hospital, Beijing, 100049, China
| | - Zheng Cai
- Peking University Third Hospital, Beijing, 100191, China
| | - Wenshuang Meng
- Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China.
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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Whelehan DF, McCarrick CA, Ridgway PF. A systematic review of sleep deprivation and technical skill in surgery. Surgeon 2020; 18:375-384. [PMID: 32057670 DOI: 10.1016/j.surge.2020.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is uncertain if sleep deprivation impacts sleepy surgeons' technical skills. Lapses in surgical performance could increase morbidity and mortality. This review concludes if sleep deprivation impacts on technical skill performance in simulated environments. OBJECTIVE Primary: 1. To identify if sleep deprivation has an impact on technical skill proficiency in surgeons. Secondary: a. To identify if the level of surgical experience, quality of sleep, or quantity of sleep influences technical skill proficiency in sleep deprived surgeons. METHODS The review was conducted according to PRISMA guidelines utilising the databases Journals Ovid. Validation followed with two independent reviewers utilising an adapted version of BEME. RESULTS Thirty-three heterogeneous studies were included. Sleep deprivation likely negatively impacts technical performance between 11.9 and 32% decrement in performance. No strong evidence exists with regards to influence of experience, sleep type, or sleep length on technical proficiency. CONCLUSION Sleepy surgeons' technical skills are, on balance, between 11.9 and 32% negatively impacted in a standardised simulated environment. This is likely to have clinical implications for patient safety.
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Affiliation(s)
- Dale F Whelehan
- Department of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
| | - Cathleen A McCarrick
- Department of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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A review of current approaches for evaluating impaired performance in around-the-clock medical professionals. Sleep Med Rev 2019; 46:97-107. [PMID: 31102878 DOI: 10.1016/j.smrv.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 01/16/2023]
Abstract
The need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide these insights. To address this issue, we performed a systematic review of relevant articles by searching the MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL databases. The literature search identified 2960 unique references, of which 82 were identified eligible. The impact on performance was studied on clinical outcomes, medical simulation, neurocognitive performance, sleep quantification and subjective assessment. In general results on performance are conflicting; impairment, no effect, and improvement were found. This review outlines the various methods currently available for assessing fatigue-impaired performance. The contrasting outcomes can be attributed to three main factors: differences in the operationalisation of fatigue, incomplete control data, and the wide variety in the methods used. We recommend the implementation of a clinically applicable tool that can provide uniform data. Until these data become available, caution should be used when developing regulations that can have implications for physicians, education, manpower planning, and ‒ ultimately ‒ patient care.
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Morales J, Yáñez A, Fernández-González L, Montesinos-Magraner L, Marco-Ahulló A, Solana-Tramunt M, Calvete E. Stress and autonomic response to sleep deprivation in medical residents: A comparative cross-sectional study. PLoS One 2019; 14:e0214858. [PMID: 30947295 PMCID: PMC6448892 DOI: 10.1371/journal.pone.0214858] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to evaluate the stress suffered by medical residents as the result of being on call for 24 hours, from a multidimensional approach. Two groups of medical residents selected according to their work shift, participated in the study: one group (n = 40) was sleep-deprived after having been actively on-call for 24 hours, and another contrast group (n = 18) had performed a normal work day and were not sleep-deprived. All participants completed pre-post measures during a 24 h cycle. These were administered on both occasions at 8 am. The measures included HRV, cortisol, cognitive performance and transitory mood. The effect of the group x phase interaction was significant for all variables analysed, indicating that doctors in the 24h on-call shift group showed significant deterioration in all physiological, performance and mood indicators in comparison with the participants in the group not on call. These results suggest the need to review medical on-call systems, in order to reduce the stress load, which has a direct effect on working conditions.
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Affiliation(s)
- Jose Morales
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
- * E-mail:
| | - Alexandre Yáñez
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Liria Fernández-González
- Department of Personality and Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | | | - Adrià Marco-Ahulló
- Unidad de lesionados medulares, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mónica Solana-Tramunt
- Faculty of Psychology, Education Sciences and Sport Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Esther Calvete
- Department of Personality and Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
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de Boer J, Van der Bogt K, Putter H, Ooms-de Vries K, Haase-Kromwijk B, Pol R, De Jonge J, Dejong K, Nijboer M, Van der Vliet D, Braat D. Surgical quality in organ procurement during day and night: an analysis of quality forms. BMJ Open 2018; 8:e022182. [PMID: 30478108 PMCID: PMC6254412 DOI: 10.1136/bmjopen-2018-022182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To analyse a potential association between surgical quality and time of day. DESIGN A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors. SETTING Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region. PARTICIPANTS In 18 months' time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003). PRIMARY OUTCOME MEASURE All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00-17:00) or evening/night-time (17:00-8:00). RESULTS Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders. CONCLUSIONS This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.
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Affiliation(s)
- Jacob de Boer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Nederlandse Transplantatie Stichting, Leiden, The Netherlands
| | - Koen Van der Bogt
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Department of Surgery, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Hein Putter
- Leids Universitair Medisch Centrum, Statistical Department, Leiden, Netherlands
| | | | | | - Robert Pol
- Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Jeroen De Jonge
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Kees Dejong
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Mijntje Nijboer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | | | - Dries Braat
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
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Robison W, Patel SK, Mehta A, Senkowski T, Allen J, Shaw E, Senkowski CK. Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator. Surg Endosc 2017; 32:1389-1396. [DOI: 10.1007/s00464-017-5820-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Ko JS, Readal N, Ball MW, Han M, Pierorazio PM. Call Schedule and Sleep Patterns of Urology Residents Following the 2011 ACGME Reforms. UROLOGY PRACTICE 2016; 3:147-152. [PMID: 27840844 DOI: 10.1016/j.urpr.2015.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In response to the 2011 Accreditation Council for Graduate Medical Education duty hour restrictions, many residency programs adopted a night float system. Due to concerns regarding the effects of night float on sleep and subsequently on patient care, we examined sleep patterns of residents on different call schedules. METHODS Urology residents assigned to day shift (Monday-Friday, 6am-6pm), night float (Sunday-Friday, 6pm-6am) or 24-hour home call and attending physicians were monitored for two-week periods using actigraphy bands. Total sleep time, light versus deep sleep time, sleep latency and number of sleep disruptions were measured. Comparative statistics and logistic regression were used to compare call systems and to determine predictors of sleep metrics. RESULTS When comparing day shift, night float, and 24-hour home call, the only significant difference was in sleep latency. All sleep variables except sleep latency were significantly different among residents of various levels (junior, senior, research year). Compared to residents, attendings had shorter sleep latency and were woken less frequently. Being a research year resident was the only significant univariate predictor of total sleep. Age and being a research year resident were significant univariate predictors of sleep latency. CONCLUSIONS This pilot study demonstrates the feasibility of actigraphy in measuring sleep patterns of urology house officers. It also suggests that night float does not significantly impact total sleep or quality of sleep. Further research is needed to confirm these findings and to determine the effects of night float rotations on resident quality of life and patient safety.
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Affiliation(s)
- Joan S Ko
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine
| | - Nathaniel Readal
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine
| | - Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine
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Weiss P, Kryger M, Knauert M. Impact of extended duty hours on medical trainees. Sleep Health 2016; 2:309-315. [PMID: 29073389 DOI: 10.1016/j.sleh.2016.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/11/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023]
Abstract
Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for duty hours have been instituted (2003) and revised (2011). These changes were based on studies of the effects of sleep deprivation on human performance and specifically on the effect of extended shifts on resident performance. These requirements necessitated significant restructuring of resident schedules. Concerns were raised that these changes have impaired continuity of care, resident education and supervision, and patient safety. We review the studies on the effect of extended work hours on resident well-being, education, and patient care as well as those assessing the effect of work hour restrictions. Although many studies support the adverse effects of extended shifts, there are some conflicting results due to factors such as heterogeneity of protocols, schedules, subjects, and environments. Assessment of the effect of work hour restrictions has been even more difficult. Recent data demonstrating that work hour limitations have not been associated with improvement in patient outcomes or resident education and well-being have been interpreted as support for lifting restrictions in some specialties. However, these studies have significant limitations and should be interpreted with caution. Until future research clarifies duty hours that optimize patient outcomes, resident education, and well-being, it is recommended that current regulations be followed.
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Affiliation(s)
- Pnina Weiss
- Section of Pediatric Respiratory Medicine and Medical Education, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064.
| | - Meir Kryger
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208057, New Haven, CT 06520-8057
| | - Melissa Knauert
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208057, New Haven, CT 06520-8057
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Dietl CA, Russell JC. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2016; 73:807-818. [PMID: 27156139 DOI: 10.1016/j.jsurg.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. DESIGN A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. RESULTS Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. CONCLUSIONS Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies.
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Affiliation(s)
- Charles A Dietl
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
| | - John C Russell
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Moeller A, Webber J, Epstein I. Resident duty hour modification affects perceptions in medical education, general wellness, and ability to provide patient care. BMC MEDICAL EDUCATION 2016; 16:175. [PMID: 27411835 PMCID: PMC4944256 DOI: 10.1186/s12909-016-0703-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 06/30/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Resident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains. METHODS Senior residents from an internal medicine training program in Canada responded to an anonymous online survey immediately before and 6 months after the implementation of duty hour reform. The survey contained questions relating to three major domains: resident wellness, ability to deliver quality health care, and medical education experience. Mean pre- and post-intervention scores were compared using the t-test for paired samples. RESULTS Twenty-three of 27 (85 %) senior residents completed both pre- and post-reform surveys. Residents perceived significant changes in many domains with duty hour reform. These included improved general wellness, less exposure to personal harm, fewer feelings of isolation, less potential for error, improvement in clinical skills expertise, increased work efficiency, more successful teaching, increased proficiency in medical skills, more successful learning, and fewer rotation disruptions. CONCLUSIONS Senior residents in a Canadian internal medicine training program perceived significant benefits in medical education experience, ability to deliver healthcare, and resident wellness after implementation of duty hour reform.
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Affiliation(s)
- Andrew Moeller
- />Division of Cardiology, Department of Medicine, Dalhousie University & Capital Health, QEII – Halifax Infirmary Site, 1796 Summer Street, B3H 3A6 Halifax, NS Canada
| | - Jordan Webber
- />Division of Cardiology, Department of Medicine, Dalhousie University & Capital Health, QEII – Halifax Infirmary Site, 1796 Summer Street, B3H 3A6 Halifax, NS Canada
| | - Ian Epstein
- />Department Medicine, Dalhousie University & Capital Health, QEII Health Sciences Centre, VG Site, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
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Fernandes S, Carvalho AF, Rodrigues AJ, Costa P, Sanz M, Goulart A, Rios H, Leão P. Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention? Int J Colorectal Dis 2016; 31:525-33. [PMID: 26744066 DOI: 10.1007/s00384-015-2494-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease. METHODS A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue. RESULTS A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime. CONCLUSIONS Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.
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Affiliation(s)
- Sofia Fernandes
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana F Carvalho
- General Surgery, Hospital of Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana J Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Moreno Sanz
- General Surgery, Complejo Hospitalario La Mancha-Centro, Cdad. Real, Spain
| | | | - Hugo Rios
- General Surgery, Hospital of Braga, Braga, Portugal
| | - Pedro Leão
- General Surgery, Hospital of Braga, Braga, Portugal. .,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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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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Liou DZ, Barmparas G, Harada M, Chung R, Melo N, Ley EJ, Salim A, Bukur M. Work Hour Reduction: Still Room for Improvement. JOURNAL OF SURGICAL EDUCATION 2016; 73:173-179. [PMID: 26319104 DOI: 10.1016/j.jsurg.2015.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The effect of resident duty hour restrictions continues to yield conflicting results on patient outcomes. Failure to rescue (FTR), or death after a major complication, has become a topic of increasing quality assessment. The aim of this study is to evaluate the effect of duty hour restrictions on in-hospital mortality, complication rates, and FTR in patients suffering traumatic injuries. DESIGN Data from the National Trauma Data Bank (NTDB) were retrospectively reviewed (Research Data Set 2007-2008 and version 7.2). Patients admitted to Level I or II teaching institutions were dichotomized into pre-duty hour restriction (2002-2003) and post-duty hour restriction (2007-2008) time periods. Patients who had nonsurvivable injuries (any region Abbreviated Injury Scale score = 6), died within 48 hours, or had missing data were excluded. Multivariate logistic regression was used to adjust for differences in patient characteristics and derive adjusted outcomes. SETTING Level I and II teaching institutions in the NTDB. PARTICIPANTS All patients with trauma admitted to a Level I or II teaching institution between January 1, 2002 and June 30, 2003 and between January 1, 2007 and December 31, 2008. RESULTS Although overall adjusted in-hospital mortality was decreased (adjusted odds ratio [AOR] = 0.7, p < 0.001) in the post-duty hour restriction era, overall complications (AOR = 2.0, p < 0.001) and FTR (AOR = 2.0, p < 0.001) were significantly higher. CONCLUSION Although there may be some benefit to resident duty hour restrictions, there is still room for improvement in patient care. Individual institutions should carefully review their own complication data to identify preventable systems issues, such as poor handoffs, and opportunities for increased resident supervision.
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Affiliation(s)
- Douglas Z Liou
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Megan Harada
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rex Chung
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicolas Melo
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ali Salim
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marko Bukur
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
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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: 145] [Impact Index Per Article: 16.1] [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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Weltz AS, Cimeno A, Kavic SM. Strategies for improving education on night-float rotations: a review. JOURNAL OF SURGICAL EDUCATION 2015; 72:297-301. [PMID: 25439176 DOI: 10.1016/j.jsurg.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/25/2014] [Accepted: 09/04/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Night float rotations (NF) have been developed as a means of achieving duty hour compliance among residency programs. These were initially pioneered in the late 1980s as a response to fatigue among residents. The NF experience had its genesis in work hour reform and providing hospital service moreso than education. However, as NF has become ubiquitous, it is not clear that we have adequately revisited the educational component of this experience. We systematically reviewed the literature on educational aspects of a night float experience. METHODS PubMed searches were conducted for the terms "night float" and "night, curriculum, residency." This yielded 320 articles. Concerning educational aspects of the NF reduced the total to 134 articles. Editorials and those concerning procedural volumes or handoffs were also excluded. Most articles used surveys as methodology, so formal statistical analysis was not possible. RESULTS In total, 42 independent articles were found that directly related to the educational value of NF rotations, spanning all of the medical disciplines. Each study was searched for interventions or strategies that may affect the educational value of the NF experience. These may be grouped broadly into 3 discrete categories: (1) attention to the sleep-wake cycle, (2) addition of personal to augment the experience and (3) incorporation of formal educational elements to night rotations. A summary of these strategies is presented in Table 3. CONCLUSIONS NF is a practical solution to the challenge of work hour restrictions in residency, and is likely to persist in the future. Some educational issues arise due to the altered physiology of a reversed sleep-wake cycle, which may be best resolved through structural limitations of the night rotations. Other deficiencies are based on lack of interactions, for which there are strategies to improving the NF educational experience.
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Affiliation(s)
- Adam S Weltz
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Arielle Cimeno
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, Maryland.
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Morrow G, Burford B, Carter M, Illing J. Have restricted working hours reduced junior doctors' experience of fatigue? A focus group and telephone interview study. BMJ Open 2014; 4:e004222. [PMID: 24604482 PMCID: PMC3948452 DOI: 10.1136/bmjopen-2013-004222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the effects of the UK Working Time Regulations (WTR) on trainee doctors' experience of fatigue. DESIGN Qualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data. SETTING 9 deaneries in all four UK nations; secondary care. PARTICIPANTS 82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry. RESULTS Implementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity. CONCLUSIONS Long-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors' true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.
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Affiliation(s)
- Gill Morrow
- Centre for Medical Education Research, Durham University, Durham, UK
| | - Bryan Burford
- School of Medical Sciences Education Development, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Madeline Carter
- Centre for Medical Education Research, Durham University, Durham, UK
| | - Jan Illing
- Centre for Medical Education Research, Durham University, Durham, UK
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Yi WS, Hafiz S, Sava JA. Effects of night-float and 24-h call on resident psychomotor performance. J Surg Res 2013; 184:49-53. [DOI: 10.1016/j.jss.2013.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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Bertram A, Hyam D, Hapangama N. Out-of-hours maxillofacial trauma surgery: a risk factor for complications? Int J Oral Maxillofac Surg 2013; 42:214-7. [DOI: 10.1016/j.ijom.2012.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 09/13/2012] [Accepted: 11/02/2012] [Indexed: 11/29/2022]
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Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med 2012; 124:241-9. [PMID: 22913912 DOI: 10.3810/pgm.2012.07.2583] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
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Zdrill E, White J. How tired is too tired? A case report. JOURNAL OF SURGICAL EDUCATION 2012; 69:826-828. [PMID: 23111054 DOI: 10.1016/j.jsurg.2012.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
We report a case involving a 32-year-old male presenting with acute delirium after completing the daily duties of his job. Though previously well, social history was positive for surgical residency. Symptom resolution was achieved with conservative treatment. We feel that this patient's clinical course represents an emerging disease entity known as "fatigue," which may have important implications for surgical training and practice.
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Neuhaus S, Igras E, Fosh B, Benson S. Part-time general surgical training in South Australia: its success and future implications (or: pinnacles, pitfalls and lessons for the future). ANZ J Surg 2012; 82:890-4. [PMID: 23088599 DOI: 10.1111/j.1445-2197.2012.06309.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Flexible training options are sought by an increasing number of Australasian surgical trainees. Reasons include increased participation of women in the surgical workforce, postgraduate training and changing attitudes to family responsibilities. Despite endorsement of flexible training by the Royal Australasian College of Surgeons and Board in General Surgery, part-time (PT) training in General Surgery in Australia and New Zealand is not well established. A permanent 'stand-alone' PT training position was established at the Royal Adelaide Hospital in 2007 under the Surgical Education and Training Program. This position offered 12 months of General Surgical training on a 0.5 full-time (FT) equivalent basis with pro rata emergency and on-call commitments and was accredited for 6 months of General Surgical training. This paper reviews the PT training experience in South Australia. METHODS De-identified logbook data were obtained from the South Australian Regional Subcommittee of the Board in General Surgery with consent of each of the trainees. Totals of operative cases were compared against matched FT trainees working on the same unit. RESULTS Overall, PT trainees achieved comparable operative caseloads compared with their FT colleagues. All trainees included in this review have subsequently passed the Royal Australasian College of Surgeons Fellowship Examination in General Surgery and returned to FT workforce positions. CONCLUSION This paper presents two validated models of PT training. Training, resource and regulatory requirements and individual and institutional barriers to flexible training are substantial. Successful PT models offer positive and beneficial training alternatives for General Surgical trainees and contribute to workforce flexibility.
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Affiliation(s)
- Susan Neuhaus
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D, Beldi G. Human factors in the operating room – The surgeon's view. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen Q, Borzecki AM, Cevasco M, Shin MH, Shwartz M, Itani KMF, Rosen AK. Examining the relationship between processes of care and selected AHRQ patient safety indicators postoperative wound dehiscence and accidental puncture or laceration using the VA electronic medical record. Am J Med Qual 2012; 28:206-13. [PMID: 23007377 DOI: 10.1177/1062860612459070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines whether Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) Postoperative Wound Dehiscence (PWD) and Accidental Puncture or Laceration (APL) events reflect problems with hospital processes of care (POC). The authors randomly selected 112 PSI-flagged PWD/APL discharges from 2002-2007 VA administrative data, identified true cases using chart review, and matched cases with controls. This yielded a total of 95 case-control pairs per PSI. Patient information and clinical processes on each case-control pair were abstracted from the electronic medical record (EMR). Although PWD cases and controls differed on incision and closure types, APL cases and controls were comparable in examined processes. Further exploration of the process differences between PWD cases and controls indicated that they were primarily caused by patients' underlying surgical problems rather than quality of care shortfalls. Documentation of POC was frequently missing in EMRs. Future studies should combine EMR review with alternative approaches, such as direct observation, to better assess POC.
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Affiliation(s)
- Qi Chen
- VA Boston Healthcare System, Boston, MA 02130, USA.
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Tjiam IM, Schout BMA, Hendrikx AJM, Scherpbier AJJM, Witjes JA, van Merriënboer JJG. Designing simulator-based training: an approach integrating cognitive task analysis and four-component instructional design. MEDICAL TEACHER 2012; 34:e698-e707. [PMID: 23088360 DOI: 10.3109/0142159x.2012.687480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Most studies of simulator-based surgical skills training have focused on the acquisition of psychomotor skills, but surgical procedures are complex tasks requiring both psychomotor and cognitive skills. As skills training is modelled on expert performance consisting partly of unconscious automatic processes that experts are not always able to explicate, simulator developers should collaborate with educational experts and physicians in developing efficient and effective training programmes. This article presents an approach to designing simulator-based skill training comprising cognitive task analysis integrated with instructional design according to the four-component/instructional design model. This theory-driven approach is illustrated by a description of how it was used in the development of simulator-based training for the nephrostomy procedure.
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Affiliation(s)
- Irene M Tjiam
- Department of Urology, Catharina Hospital Eindhoven, The Netherlands.
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Kahol K, Huston C, Hamann J, Ferrara JJ. Initial experiences in embedding core competency education in entry-level surgery residents through a nonclinical rotation. J Grad Med Educ 2011; 3:95-9. [PMID: 22379529 PMCID: PMC3186258 DOI: 10.4300/jgme-d-10-00103.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/06/2010] [Accepted: 10/20/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. AIM Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. METHODS We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. RESULTS By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. CONCLUSION Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.
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Affiliation(s)
- Kanav Kahol
- Corresponding author: Kanav Kahol, PhD, School of Biological and Health Systems Engineering, Arizona State University, PO Box 878809, Tempe, AZ,
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