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Senociain Gonzalez JE, Dominguez Torres LC. Transferencia de autonomía operatoria en apendicectomía abierta y laparoscópica: Un estudio de métodos mixtos desde la perspectiva de residentes y supervisores. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Existe información limitada sobre el desarrollo apropiado de curvas quirúrgicas de aprendizaje, con altos niveles de autonomía, en residentes de cirugía general en Colombia. El objetivo de este estudio fue caracterizar los niveles de autonomía, para la realización de apendicectomía laparoscópica o abierta en un programa de especialización, desde la perspectiva de médicos residentes y supervisores.
Métodos. Estudio de métodos mixtos que se realizó en dos fases. La primera fase incluyó la recolección prospectiva de la información de cada procedimiento (apendicectomía abierta o laparoscópica), realizado entre agosto de 2015 y diciembre de 2018, en la que participaron 29 médicos residentes. Cada residente evaluó su función (cirujano, ayudante), el nivel de supervisión y el nivel de autonomía intraoperatoria mediante la Escala de Zwisch (EZ). En la segunda fase (cualitativa), se realizaron entrevistas a un total de 15 cirujanos generales que supervisaron la práctica de los residentes con preguntas que buscaban explicar los hallazgos cuantitativos.
Resultados. Se analizaron 1732 intervenciones: 629 (36 %) se realizaron por vía abierta y 1103 (63 %) por vía laparoscópica. El 81,4 % (n=1411) de los procedimientos fueron realizados en hospitales privados. La percepción global de autonomía reportada por los residentes de acuerdo con la Escala de Zwisch tuvo nivel A 28,9 % (n=500), nivel B 18,1 % (n=313), nivel C 30,4 % (n=526) y nivel D 22,7 % (n=393). El 35,2 % (n=388) de apendicectomías laparoscópicas y el 17,8% (n=112) por vía abierta fueron realizadas con un nivel A, mientras el 19,5 % (n=215) de apendicectomías laparoscópicas y el 28,2 % (n=178) por vía abierta fueron realizadas con un nivel D. La explicación dada de los hallazgos cuantitativos fue la frecuencia de apendicectomías abiertas en hospitales públicos, aspectos relacionados con la transferencia de autonomía hacia el residente y el aumento progresivo en el nivel de autonomía avanzada entre 2015-2018.
Discusión. Se encontró un mayor nivel de autonomía en la realización de apendicectomía por vía abierta comparada con la vía laparoscópica, y los niveles de autonomía fueron mayores en hospitales públicos. La explicación a estos hallazgos estuvo relacionada con el contexto clínico y profesional de los residentes.
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Hassan NM, Abu-Elenin MM, Elsallamy RM, Kabbash IA. Job stress among resident physicians in Tanta University Hospitals, Egypt. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:37557-37564. [PMID: 32157529 DOI: 10.1007/s11356-020-08271-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
Resident physicians are the first-line health service providers, subjected to prolonged working hours, sleep deprivation and high job demands. Work stress causes reduction in productivity, suboptimal patient care and medical errors. To determine the level of stress among residents and associated factors and stressors. A cross-sectional study at Tanta University Hospitals recruited residents (n = 278), between December 2016 and February 2017. Job stress was assessed using a predesigned questionnaire. The mean age was 26.53 ± 1.35, and 46.4% were males. The majority reported they work more than 48 h/week, do not get a break during work and have a night shift periodically (87%, 83.1% and 94.2%, respectively). Only 4 (1.4%) had low stress while 169 (60.8%) had moderate and 105 (37.8%) had high stress. The study revealed a statistically significant association between high level of stress and being a single resident (p = 0.017), belonging to surgical departments (p = 0.001) and an absence of break during working hours (p = 0.001). The prime sources of stress were underpayment for the job (87.4%), serving to large number of patients (85.2%), disruption of home life due to long hours at work (83.9%), conflict of responsibilities (81.3) and complying with increasing bureaucratic procedures (78.8%) besides no available fund for research (74.8%). Medical residents experienced moderate to high level of job stress. Thus, there is a need for stress management programs during residency training period taking in consideration main sources of stress.
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Affiliation(s)
- Nadira Mansour Hassan
- Public Health & Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mira M Abu-Elenin
- Public Health & Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rania M Elsallamy
- Occupational Medicine in Public Health & Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim A Kabbash
- Public Health & Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Maswadi N, Khader YS, Abu Slaih A. Perceived Stress Among Resident Doctors in Jordanian Teaching Hospitals: Cross-Sectional Study. JMIR Public Health Surveill 2019; 5:e14238. [PMID: 31579024 PMCID: PMC6777282 DOI: 10.2196/14238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/02/2022] Open
Abstract
Background Medical residents in Jordanian hospitals are involved in many clinical and nonclinical tasks that expose them to various stress factors. High stress and burnout have the potential to negatively impact work performance and patient care, including medication errors, suboptimal care, clinical errors, and patient dissatisfaction. Objective This study aimed to determine the perceived stress among medical residents in Jordanian hospitals and its associated risk factors. Methods A cross-sectional study was conducted among residents in Jordanian hospitals. A cluster sample of 5 hospitals with residency programs was selected from different health sectors. All residents who were working in the selected hospitals were invited to participate in this study, during the period from April to July 2017. A total of 555 residents agreed to participate in this study, giving a response rate of 84%. The perceived stress scale (PSS) was used for assessment. Results A total of 398 male and 157 female residents were included in this study. The mean PSS score in this study was 21.6; 73% (405/555) of the residents had moderate level of stress, and 18% (100/555) had high level of stress. About 6.7% (37/555) of the residents had hypertension, 2.7% (15/555) had diabetes, 3.2% (18/555) had heart disease, and 8.5% (47/555) were anemic. 233 (42%) respondents complained of back pain, and 161 (29%) of the respondents complained of insomnia. Stress was associated with higher workload, sleep deprivation, and dissatisfaction in the relationship with colleagues, with income, and with the program. In multivariate analysis, the following factors were significantly associated with stress: female gender, dissatisfaction with working environment, and facing work-related, academic, and family stressors. Conclusions The majority of medical residents in Jordanian hospitals felt nervous and stressed. Conducting stress management programs during residency and improving the work environment are strongly recommended.
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Affiliation(s)
- Nizar Maswadi
- Department of Parasitic and Zoonotic Diseases, Directorate of Communicable Diseases, Ministry of Health, Amman, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Ahmad Abu Slaih
- Community Medicine Residency Program, Jordan Ministry of Health, Amman, Jordan
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Salles A, Wright RC, Milam L, Panni RZ, Liebert CA, Lau JN, Lin DT, Mueller CM. Social Belonging as a Predictor of Surgical Resident Well-being and Attrition. JOURNAL OF SURGICAL EDUCATION 2019; 76:370-377. [PMID: 30243929 PMCID: PMC6380922 DOI: 10.1016/j.jsurg.2018.08.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/23/2018] [Accepted: 08/23/2018] [Indexed: 05/16/2023]
Abstract
OBJECTIVE In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition. DESIGN Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program). SETTING We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017). PARTICIPANTS Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included. RESULTS One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001). CONCLUSIONS Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.
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Affiliation(s)
- Arghavan Salles
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
| | - Robert C Wright
- Psychology Department, University of California, Riverside, Riverside, California.
| | - Laurel Milam
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
| | - Roheena Z Panni
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
| | - Cara A Liebert
- Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, Stanford, California.
| | - James N Lau
- Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, Stanford, California.
| | - Dana T Lin
- Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, Stanford, California.
| | - Claudia M Mueller
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, California.
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Jiang Y, Guan YJ, Dai DW, Huang W, Huang ZY. Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program: A cross-sectional study. PLoS One 2019; 14:e0207258. [PMID: 30615626 PMCID: PMC6322717 DOI: 10.1371/journal.pone.0207258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/29/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It has been widely understood that well-trained doctors are crucial for a high-quality public health system and safe patient care. Thus, in 2011, China initiated its first national residency training program, called the China Standardized Training for Resident Doctor (C-STRD), for medical graduates to prepare qualified doctors for the medical care system with increasing demands. So far, no studies have specifically address the prevalence of stress and its determinants among residents enrolled in the C-STRD. PARTICIPANTS AND METHODS The research is performed in two stages. In stage I, the authors conducted a pilot study and met 112 C-STRD residents in person. Based on the preliminary data, a revised questionnaire was adopted in stage II, during which the authors conducted a multi-institutional, cross-sectional survey of 340 participants from 11 hospitals in Shanghai in a self-administered manner. RESULTS The results showed that C-STRD residents were overall under severe stress as their mean PSS score was 27.5 ± 4.9, which was higher than the threshold of high stress (PSS = 20). Specifically, the PSS score for the residents with Bachelor (MB), Master (MM) and Doctoral of Medicine (MD) educational degree were 26.6 ± 4.1, 27.8 ± 3.5 and 27.1 ± 5.2, respectively (P>0.05). Their stress was mainly associated with their financial income status and workload, as these two factors caused more severe burden than other listed stressors (P<0.05). Specially, the residents indicated that their montly payroll amout were as low as $590.2 ± 127 while no benefit package and allowance were given. Surprisingly, wage arrears up to 5.3 month were reported by 36 (10%) participants. Workload survey showed the residents has high work intensity and inadequate rest. Since no stress management program was provided, the majority of residents tended to cope their stress with unhealthy strategies, such as mesmerizing in TV/computer (88.2%) and overeating (59.7%). CONCLUSION The C-STRD residents are at high risk of perceived stress. Although there was a difference in perception of stress for workload and career future among different educational degree owners, low financial income is the major stressor among all C-STRD residents. Unhealthy stress management strategies were adopted by all residents due to lack of appropriate stress-relieving intervention.
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Affiliation(s)
- Ying Jiang
- Department of Medicine, New Jersey Medical School Affiliated to Rutgers University, Rutgers University, Newark, New Jersey, United States
- * E-mail:
| | - Yan-Jun Guan
- Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, Shanghai, PR China
| | - Da-Wei Dai
- Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, Shanghai, PR China
| | - Wei Huang
- Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, Shanghai, PR China
| | - Zhen-Yu Huang
- Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, Shanghai, PR China
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Kevric J, Papa N, Perera M, Rashid P, Toshniwal S. Poor Employment Conditions Adversely Affect Mental Health Outcomes Among Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2018; 75:156-163. [PMID: 28729187 DOI: 10.1016/j.jsurg.2017.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/17/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Poor mental health in junior clinicians is prevalent and may lead to poor productivity and significant medical errors. We aimed to provide contemporary data on the mental health of surgical trainees and identify risk factors relating to poorer mental health outcomes. METHODS A detailed questionnaire was developed comprising questions based on the 36-item short-form health survey (SF-36) and Physical Activity Questionnaire. Each of the questionnaires has proven validity and reliability in the clinical context. Ethics approval was obtained from the Royal Australasian College of Surgeons. The questionnaire was aimed at surgical registrars. We used Physical Activity Questionnaire, SF-36 scores and linear regression to evaluate the effect of putative predictors on mental health. RESULT A total of 83 responses were collected during the study period, of which 49 (59%) were from men and 34 (41%) were from women. The mean Mental Component Summary (MCS) score for both sexes was significantly lower than the population mean at ages 25-34 (p < 0.001). Poor satisfaction with one's work culture and a feeling of a lack of support at work were extremely strong predictors of a lower MCS score (p < 0.001). Hours of overtime worked, particularly unpaid overtime, were also strong predictors of a poorer score. CONCLUSIONS Australian surgical trainees reported lower MCS scores from the SF-36 questionnaire compared to the general population. Increasing working hours, unpaid overtime, poor job security, and job satisfaction were associated with poorer scores among trainees. Interventions providing improved working conditions need to be considered by professional training bodies and employers.
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Affiliation(s)
- Jasmina Kevric
- Department of Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia.
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia; Division of Surgery, Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia; Division of Surgery, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Sumeet Toshniwal
- Department of Surgery, Angliss Hospital, Eastern Health, Melbourne, Victoria, Australia
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Le HM, Young SD. Evaluation of stress experienced by pharmacy residents. Am J Health Syst Pharm 2017; 74:599-604. [DOI: 10.2146/ajhp150763] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hung M. Le
- VA Texas Valley Coastal Bend Health Care System, Harlingen, TX
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Alosaimi FD, Kazim SN, Almufleh AS, Aladwani BS, Alsubaie AS. Prevalence of stress and its determinants among residents in Saudi Arabia. Saudi Med J 2016; 36:605-12. [PMID: 25935183 PMCID: PMC4436759 DOI: 10.15537/smj.2015.5.10814] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: To examine perceived stress among residents in Saudi Arabia and its associated risk factors. Methods: A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS). Results: Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession. Conclusion: Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. E-mail.
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Soares DS, Chan L. Stress and wellbeing of junior doctors in Australia: a comparison with American doctors and population norms. BMC MEDICAL EDUCATION 2016; 16:183. [PMID: 27435724 PMCID: PMC4949893 DOI: 10.1186/s12909-016-0693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/21/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Stress in doctors adversely affects decision-making, memory, information-recall and attention, thereby negatively impacting upon the provision of safe and high quality patient care. As such, stress in doctors has been subject to increasing scientific scrutiny and has amassed greater public awareness in recent years. The aims of this study are to describe stress levels and the psychological wellbeing of current junior medical officers (JMOs), and to compare this to their predecessors, American surgical residents and population norms. METHODS Post graduate years 1 & 2 doctors at a single metropolitan tertiary referral center were surveyed in 2009 and 2014 using two reliable and validated psychometric questionnaires, the Short Form-36 (SF36) and Perceived Stress Scale-14 (PSS14), with additional questions pertaining to demographics and training. The results were compared with published data from American general surgical residents and Australian age-matched population norms. RESULTS Mean stress levels were lower in 2014 (23 ± 7.2) than in 2009 (27.2 ± 7.6) (p = 0.017). The mean PSS-14 score was lower than that of American surgical residents, both before (26.8 ± 7.3, p = 0.003) and after (26.7 ± 8.2, p = 0.004) implementation of the safe working hour policies but higher than societal controls (p < 0.0001). Whilst JMOs in 2014 reported better overall mental health compared to those in 2009 (p = 0.02), they were significantly worse than the general population (p = 0.009). Multivariate analysis showed that JMOs were more likely to have a high PSS-14 score or to have a low mental health score if they reported higher career anxiety (p < 0.05). CONCLUSIONS Doctors are still at risk despite an improvement in their stress levels and overall mental health. They are less likely to be stressed and to have better mental health if they have less career-related anxiety. This has implications for the medical education and training of our junior doctors.
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Affiliation(s)
- Deanne S. Soares
- Department of Urology, Concord Repatriation General Hospital, Sydney, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, Australia
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Dimou FM, Eckelbarger D, Riall TS. Surgeon Burnout: A Systematic Review. J Am Coll Surg 2016; 222:1230-1239. [PMID: 27106639 DOI: 10.1016/j.jamcollsurg.2016.03.022] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/04/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX.,Department of Surgery, University of South Florida, Tampa, FL
| | - David Eckelbarger
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Taylor S Riall
- Department of Surgery, University of Arizona, Banner-University Medical Center, Tucson, AZ
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Beyond the body: A systematic review of the nonphysical effects of a surgical career. Surgery 2016; 159:650-64. [DOI: 10.1016/j.surg.2015.08.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/06/2015] [Accepted: 08/15/2015] [Indexed: 12/21/2022]
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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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The impact of hospital overcrowding on postgraduate education: an emergency medicine resident's perspective through the lens of CanMEDS. CAN J EMERG MED 2015; 11:247-9. [DOI: 10.1017/s1481803500011295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Shelton J, Kummerow K, Phillips S, Arbogast PG, Griffin M, Holzman MD, Nealon W, Poulose BK. Patient safety in the era of the 80-hour workweek. JOURNAL OF SURGICAL EDUCATION 2014; 71:551-559. [PMID: 24776874 PMCID: PMC4852697 DOI: 10.1016/j.jsurg.2013.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/13/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In 2003, duty-hour regulations (DHR) were initially implemented for residents in the United States to improve patient safety and protect resident's well-being. The effect of DHR on patient safety remains unclear. The study objective was to evaluate the effect of DHR on patient safety. DESIGN Using an interrupted time series analysis, we analyzed selected patient safety indicators (PSIs) for 376 million discharges in teaching (T) vs nonteaching (NT) hospitals before and after implementation of DHR in 2003 that restricted resident work hours to 80 hours per week. The PSIs evaluated were postoperative pulmonary embolus or deep venous thrombosis (PEDVT), iatrogenic pneumothorax (PTx), accidental puncture or laceration, postoperative wound dehiscence (WD), postoperative hemorrhage or hematoma, and postoperative physiologic or metabolic derangement. Propensity scores were used to adjust for differences in patient comorbidities between T and NT hospitals and between discharge quarters. The primary outcomes were differences in the PSI rates before and after DHR implementation. The PSI differences between T and NT institutions were the secondary outcome. SETTING T and NT hospitals in the United States. PARTICIPANTS Participants were 376 million patient discharges from 1998 to 2007 in the Nationwide Inpatient Sample. RESULTS Declining rates of PTx in both T and NT hospitals preintervention slowed only in T hospitals postintervention (p = 0.04). Increasing PEDVT rates in both T and NT hospitals increased further only in NT hospitals (p = 0.01). There were no differences in the PSI rates over time for hemorrhage or hematoma, physiologic or metabolic derangement, accidental puncture or laceration, or WD. T hospitals had higher rates than NT hospitals both preintervention and postintervention for all the PSIs except WD. CONCLUSIONS Trends in rates for 2 of the 6 PSIs changed significantly after DHR implementation, with PTx rates worsening in T hospitals and PEDVT rates worsening in NT hospitals. Lack of consistent patterns of change suggests no measurable effect of the policy change on these PSIs.
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Affiliation(s)
- Julia Shelton
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristy Kummerow
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick G Arbogast
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marie Griffin
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, VA Medical Center, Nashville, Tennessee
| | - Michael D Holzman
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William Nealon
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin K Poulose
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Limiting Resident Work Hours: The Case for the 80-Hour Work Week. J Oral Maxillofac Surg 2012; 70:1246-8. [DOI: 10.1016/j.joms.2011.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/15/2011] [Indexed: 11/22/2022]
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Trout AT, Wang PI, Cohan RH, Bailey JE, Khalatbari S, Myles JD, Dunnick NR. Apprenticeships ease the transition to independent call: an evaluation of anxiety and confidence among junior radiology residents. Acad Radiol 2011; 18:1186-94. [PMID: 21719320 DOI: 10.1016/j.acra.2011.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/08/2011] [Accepted: 04/09/2011] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to quantify resident anxiety when beginning independent call and to assess whether an apprenticeship experience (buddy call) can lessen anxiety and improve confidence. MATERIALS AND METHODS A prospective cohort comparison of two groups of radiology residents beginning independent call, one of which was provided with a buddy call experience, was performed. Anxiety and confidence were assessed using the Endler Multidimensional Anxiety Scales-State (EMAS-S), with total score, autonomic emotional, and cognitive worry components, and a five-point, Likert-type scale, respectively. Both groups were asked about the perceived value of a buddy call experience. RESULTS EMAS-S scores improved significantly over 5 days of call in both groups (control, n = 10, P = .0005; buddy call, n = 9, P = .0001), and image interpretation confidence correspondingly increased (control, P = .0004; buddy call, P = .003). Compared to the control group, autonomic emotional scores were significantly lower in the buddy call group on the first day of independent call (P = .040), and cognitive worry and total EMAS-S scores were significantly lower on day 5 (both P values = .03). Buddy call was independently associated with improved autonomic emotional and film interpretation confidence scores (both P values = .02). All members of the buddy call group indicated that the experience was very helpful in preparing for call. CONCLUSIONS Beginning independent call is associated with high anxiety, and buddy call reduces that anxiety, beyond the effect of time alone. Residents who participated in buddy call found it helpful in preparing for independent call. These findings support the use of buddy call and tiered call structures as means to introduce junior residents to independent call.
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Wrenn K, Lorenzen B, Jones I, Zhou C, Aronsky D. Factors affecting stress in emergency medicine residents while working in the ED. Am J Emerg Med 2010; 28:897-902. [DOI: 10.1016/j.ajem.2009.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 04/16/2009] [Accepted: 05/11/2009] [Indexed: 10/19/2022] Open
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Griner D, Menon RP, Kotwall CA, Clancy TV, Hope WW. The eighty-hour workweek: surgical attendings' perspectives. JOURNAL OF SURGICAL EDUCATION 2010; 67:25-31. [PMID: 20421086 DOI: 10.1016/j.jsurg.2009.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 11/16/2009] [Accepted: 12/07/2009] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The year 2008 was a sentinel year in resident education; this was the first graduating general surgery class trained entirely under the 80-hour workweek. The purpose of this study was to evaluate attending surgeon perceptions of surgical resident attitudes and performance before and after duty-hour restrictions. DESIGN An electronic survey was sent to all surgical teaching institutions in North Carolina. Both surgeon and hospital characteristics were documented. The survey consisted of questions designed to assess residents' attitudes/performance before and after the implementation of the work-hour restriction. RESULTS In all, 77 surveys were returned (33% response rate). The survey demonstrated that 92% of educators who responded to the survey recognized a difference between the restricted residents (RRs) and the nonrestricted residents (NRRs), and most respondents (67%) attributed this to both the work-hour restrictions and the work ethic of current residents. Most attending surgeons reported no difference between the RRs and the NRRs in most categories; however, they identified a negative change in the areas of work ethic, technical skills development, decision-making/critical-thinking skills, and patient ownership among the RR group. Most surgeons expressed less trust (55%) with patient care and less confidence (68%) in residents' ability to operate independently in the RR group. Eighty-nine percent indicated that additional decreases in work hours would continue to hamper the mission of timely and comprehensive resident education. CONCLUSIONS The perception of surgical educators was that RRs are clearly different from the NRRs and that the primary difference is in work ethic and duty-hour restrictions. Although similar in most attributes, RRs are perceived as having a lower baseline work ethic and a less developed technical skill set, decision-making ability, and sense of patient ownership. Subsequent study is needed to evaluate these concerns.
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Affiliation(s)
- Devan Griner
- Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, North Carolina 28401, USA
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Tillou A, Hiatt JR, Leonardi MJ, Quach C, Hines OJ. Protected educational rotations: a valuable paradigm shift in surgical internship. JOURNAL OF SURGICAL EDUCATION 2008; 65:465-469. [PMID: 19059179 DOI: 10.1016/j.jsurg.2008.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 05/19/2008] [Accepted: 07/16/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The first year of surgical training sometimes includes marginally educational or service-related tasks with limited direct interactions with faculty. We instituted a prototype rotation to address the changing needs and expectations of our intern class. This study was designed to evaluate the new rotation 17 months after it was implemented. DESIGN Interns spend 4 weeks in our outpatient surgery center. Elements of the rotation include performance of operative cases and perioperative management of outpatients under direct faculty supervision, daily one-on-one structured teaching sessions with faculty, and call coverage twice monthly. At the conclusion of the rotation, interns make a presentation on a topic of their choosing to a teaching conference. Rotation evaluations and case and work-hour logs for the outpatient surgery rotation (OSR) were compared with those for the remaining intern rotations combined. A faculty survey of the OSR also was conducted. RESULTS The OSR consistently received maximum overall ratings (4 of 4), significantly higher than the average overall score for the remaining rotations (3.17, p < 0.01). Similarly, teaching by faculty, time spent in the operating room, and quality of operating room time were rated significantly higher than for the other intern rotations (p </= 0.05). Interns performed an average of 44 cases in 4 weeks of OSR, compared with an average of 94 in the remaining rotations (p < 0.001), and they worked an average of 62 hours per week (range, 49-76 hours). Of the participating faculty, 93% reported that the interaction gave them the opportunity to know the interns better at a personal level, that the sessions were beneficial and improved working relationships with interns, and that the program should continue. CONCLUSIONS Changing program requirements, time restrictions, public scrutiny, and increasing awareness for quality of life all obligate a paradigm shift in surgical education. Our outpatient rotation is logistically simple and rewarding both for residents and faculty.
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Affiliation(s)
- Areti Tillou
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-6904, USA.
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Ratanawongsa N, Wright SM, Carrese JA. Well-being in residency: effects on relationships with patients, interactions with colleagues, performance, and motivation. PATIENT EDUCATION AND COUNSELING 2008; 72:194-200. [PMID: 18541401 DOI: 10.1016/j.pec.2008.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 04/16/2008] [Accepted: 04/27/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Previous studies about resident well-being have focused on negative aspects of well-being. We conducted this study to explore residents' conceptions of well-being and how it affects their work. METHODS One investigator conducted semi-structured interviews with residents at two hospitals during February-June 2005. Through random sampling stratified by program and gender, we invited 49 residents from internal medicine, psychiatry, surgery, emergency medicine, anesthesia, obstetrics/gynecology, and pediatrics. Using an editing analysis style, three investigators independently coded transcripts. RESULTS 26 residents participated in 45-min interviews. Residents acknowledged that well-being affected four elements of their work: relationships with patients, interactions with colleagues, performance, and motivation. Residents described higher quality discussions with patients when their well-being was high and inappropriate exchanges when well-being was low. Residents attributed conflict with colleagues to lower states of well-being. Residents felt they had improved decision-making when their well-being was higher. Residents' motivation in their daily work and career varied with fluctuating well-being. Five residents initially denied that their well-being affects their work, voicing concerns that this would be unprofessional. CONCLUSIONS Most residents felt that both high and low levels of well-being affected their work, particularly their work relationships. PRACTICE IMPLICATIONS The educational and patient care goals of residency training may be enhanced through interventions that promote resident well-being.
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Affiliation(s)
- Neda Ratanawongsa
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Dimitris KD, Taylor BC, Fankhauser RA. Resident work-week regulations: historical review and modern perspectives. JOURNAL OF SURGICAL EDUCATION 2008; 65:290-6. [PMID: 18707663 DOI: 10.1016/j.jsurg.2008.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/21/2008] [Accepted: 05/26/2008] [Indexed: 05/20/2023]
Affiliation(s)
- Kirk D Dimitris
- Department of Orthopedic Surgery Mount Carmel Health System, Columbus, Ohio 43222, USA
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Abstract
Residents on call experience decreased total sleep time (TST) and increased dysphoria. This study monitored changes in mood and sleepiness for 3 post-call days. Fifty-two internal medicine residents participated in the study. The residents wore actigraphs for the 4 to 9 days of the study. Each morning resident completed mood scales, a sleepiness scale, and estimated their prior night TST. The residents were on a 1-in-4 schedule. Call decreased subjective- and actigraphy-derived TST to less than 4 hr. During the 3 days post call, mood measures improved. Tension, depression, and anxiety stabilized on the first post-call day following the first night of off-call sleep during which the residents obtained about 7 hr of sleep. Vigor, fatigue, and confusion stabilized on the second post-call day. The Epworth Sleepiness Scale dropped to less than 11 after 1 post-call night and continued to decrease up to 3 post-call days. The effects of call linger past the first recovery night. For these residents, recovery sleep appeared inadequate, and the negative effects of call persisted across succeeding off-call days. Thus, for these residents on a 1-in-4 schedule, call affects their mood for much of the time when off call and potentially their personal and professional interactions during this period as well.
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Affiliation(s)
- Mary Rose
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
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Shanafelt T. A career in surgical oncology: finding meaning, balance, and personal satisfaction. Ann Surg Oncol 2007; 15:400-6. [PMID: 18071823 PMCID: PMC2244698 DOI: 10.1245/s10434-007-9725-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 11/02/2007] [Indexed: 11/18/2022]
Abstract
The practice of surgical oncology provides opportunities for both personal distress as well as personal satisfaction. While many surgical oncologists experience career burnout, others derive great meaning and satisfaction from their work. In this article, we review the literature on surgeon burnout, discuss potential personal and professional consequences, and consider steps individual surgeons can take to promote personal and professional satisfaction.
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Affiliation(s)
- Tait Shanafelt
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Ratanawongsa N, Wright SM, Carrese JA. Well-being in residency: a time for temporary imbalance? MEDICAL EDUCATION 2007; 41:273-80. [PMID: 17316212 DOI: 10.1111/j.1365-2929.2007.02687.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CONTEXT Previous quantitative studies about doctor well-being have focused primarily on negative well-being, such as burnout. We conducted this study to understand residents' perspectives on well-being. METHODS We conducted 45-minute interviews with residents from 9 residencies at 2 academic hospitals in Baltimore, Maryland. From February to June 2005, we approached 49 residents through random sampling stratified by programme and gender. The semi-structured instrument elicited descriptions of well-being in residency and factors related to its promotion or reduction. Using an editing analysis style, investigators independently coded transcripts, agreeing on the coding template and its application. RESULTS The 26 participating residents came from internal medicine (3 programmes), psychiatry, surgery, emergency medicine, anaesthesia, obstetrics and gynaecology, and paediatrics. Six themes emerged: balance among multiple domains; professional development and temporary imbalance; professional satisfaction and accomplishment; maintaining a sense of self; stressors and coping strategies, and the role of residency programmes. Residents described well-being as a balance among multiple domains, including professional development, relationships, and physical and mental health. They viewed residency as a time for temporary imbalance, during which they invested in professional development at the expense of other domains. Some residents described feeling a 'loss of self'. Residents revealed strategies for coping with stressors and endorsed ways in which training programmes helped to enhance their well-being. CONCLUSIONS Resident well-being was closely connected to professional development and required varying degrees of self-sacrifice with a re-balancing of personal priorities. These findings should be considered by training programmes that are interested in enhancing resident well-being.
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Affiliation(s)
- Neda Ratanawongsa
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Kusuma SK, Mehta S, Sirkin M, Yates AJ, Miclau T, Templeton KJ, Friedlaender GE. Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents. J Bone Joint Surg Am 2007; 89:679-85. [PMID: 17332119 DOI: 10.2106/jbjs.f.00526] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature on graduate medical education contains anecdotal reports of some effects of the new eighty-hour workweek on the attitudes and performance of residents. However, there are relatively few studies detailing the attitudes of large numbers of residents in a particular surgical specialty toward the new requirements. METHODS Between July and November 2004, a survey created by the Academic Advocacy Committee of the American Academy of Orthopaedic Surgeons was distributed by mail, fax, and e-mail to a total of 4207 orthopaedic residents at the postgraduate year-1 through year-6 levels of training. The survey responses were tabulated electronically, and the results were recorded. RESULTS The survey response rate was 13.2% (554 residents). Sixty-eight percent (337) of the 495 respondents whose postgraduate-year level was known were at the postgraduate year-4 level or higher. Attitudes concerning the duty rules were mixed. Twenty-three percent of the 554 respondents thought that eighty hours constituted an appropriate number of duty hours per week; 41% believed that eighty hours were too many, and 34% thought that eighty hours were not sufficient. Thirty-three percent of the respondents had worked greater than eighty hours during at least a single one-week period since the new rules were implemented; this occurred more commonly among the postgraduate year-3 and more junior residents. Orthopaedic trauma residents had the most difficulty adhering to the new duty-hour restrictions. Eighty-two percent of the respondents indicated that their residency programs have been forced to make changes to their call schedules or to hire ancillary staff to address the rules. The use of physician assistants, night-float systems, and so-called home-call assignments were the most common strategies used to achieve compliance. CONCLUSION Resident attitudes toward the work rules are mixed. The rules have forced residency programs to restructure. Junior residents have more favorable attitudes toward the new standards than do senior residents. Self-reporting of duty hours is the most common method of monitoring in orthopaedic training programs. Such systems allow ample opportunity for inaccuracies in the measurement of hours worked. Although residents report an improved quality of life as a result of these new rules, the attitude that the quality of training is diminished persists.
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Affiliation(s)
- Sharat K Kusuma
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104, USA.
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Abstract
In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts >30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 ± 0.5 vs Likert score 2.5 ± 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with <1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.
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Zaré SM, Galanko JA, Behrns KE, Sieff EM, Boyle LM, Farley DR, Evans SRT, Meyer AA, Farrell TM. Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study. Surgery 2005; 138:150-7. [PMID: 16153421 DOI: 10.1016/j.surg.2005.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 05/09/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our published data from the preceding year indicated significant impairment in psychologic well-being among surgery residents. The purpose of this study was to determine whether psychologic well-being and academic performance of surgery residents improved after inception of the 80-hour workweek. METHODS A single-blinded survey of general surgery residents (n=130) across 4 US training programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom Checklist-90-R and Perceived Stress Scale) and the American Board of Surgery In-Training Examination; comparison was done with preceding year and societal data. Primary outcomes were "psychologic distress" and "perceived stress." Secondary outcomes were "somatization," "depression," "anxiety," "interpersonal sensitivity," "hostility," "obsessive-compulsive behavior," "phobic anxiety," "paranoid ideation," "psychoticism." and "academic performance." The impact of demographic variables was assessed. RESULTS Mean psychologic distress improved from the preceding year (P < .01) but remained elevated, compared with societal norms (P < .001). The proportion of residents meeting the criteria for clinical psychologic distress (>or=90th percentile) decreased from 38% before, to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P < .0001) without improvement from the preceding year. Overall academic performance was unchanged. Previously elevated secondary psychologic outcomes improved after July 2003 (P < .05), although obsessive-compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to normalize. Male gender and single status were independent risk factors for psychologic distress. CONCLUSIONS Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents. The perception of stress and academic performance remains unchanged.
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Affiliation(s)
- S Mahmood Zaré
- Department of Surgery, Boston VA Health Care System, MA, USA
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Gadacz TR, Bason JJ. A Survey of the Work Effort of Full-time Surgeons of the Southeastern Surgical Congress. Am Surg 2005. [DOI: 10.1177/000313480507100811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a survey research project to determine the work hours of practicing surgeons and compare those hours with hours that have been mandated for graduate medical education programs by the Accreditation Council for Graduate Medical Education (ACGME). The survey conducted of the membership of the Southeastern Surgical Congress focused on the amount of time devoted to professional activity. Although several categories of membership were surveyed, those surgeons in full-time practice were used for this report. Five hundred ninety-two general surgeons and some surgical specialties from 17 states reported a total professional work effort of 65 hours per week averaged over a month. Twenty per cent reported working more than 80 hours per week. Statistically significant ( P < 0.05) factors that characterized these individuals included years in practice (1 to 10 years), more clinical hours per week, fewer administrative hours per week, fewer teaching hours per week, fewer continuing medical education (CME) hours per year, and an increase in recent clinical practice. Interestingly, there was no significant difference in CME over a 2- or 5-year period. Other factors such as type of practice did not have statistical significance. There was no difference between states and no difference in time commitment to political or community activities. This survey indicates that surgeons going into practice in the Southeast from general surgery graduate medical education programs can expect to have a mean work week of 65 hours, and 20 per cent can expect to exceed an 80-hour work week.
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Mcelearney ST, Saalwachter AR, Hedrick TL, Pruett TL, Sanfey HA, Sawyer RG. Effect of the 80-Hour Work Week on Cases Performed by General Surgery Residents. Am Surg 2005. [DOI: 10.1177/000313480507100703] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) implemented mandatory work week hours restrictions in 2003. Due to the traditionally long hours in general surgery, the effect of restrictions on surgical training and case numbers was a matter of concern. Data was compiled retrospectively from ACGME logs and operating room (OR) records at a university hospital for 2002 and 2003. Work week restrictions began in January 2003. This data was reviewed to determine resident case numbers, both in whole and by postgraduate year (PGY). Mean case numbers per resident-month in 2002 were 8.8 ± 8.2 for PGY1s, 16.2 ± 15.7 for PGY2s, 31.4 ± 12.9 for PGY3s, 31.5 ± 17.6 for PGY4s, and 31.5 ± 17.6 for PGY5s. In 2003, they were 8.8 ± 5.2 for PGY1s, 16.6 ± 13.9 for PGY2s, 27.8 ± 12.5 for PGY3s, 38.2 ± 18.8 for PGY4s, and 26.1 ± 9.6 for PGY5s. PGY1s, PGY2s, PGY3s, PGY4s, or all classes were not statistically different. PGY5s did have statistically fewer cases in 2003 ( P = 0.03). PGY5s did have statistically fewer cases after the work-hours restriction, which likely represented shifting of postcall afternoon cases to other residents. Comparing other classes and all PGYs, case numbers were not statistically different. Operative training experience does not appear to be hindered by the 80-hour work week.
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Affiliation(s)
| | - Alison R. Saalwachter
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy L. Pruett
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Hilary A. Sanfey
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert G. Sawyer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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Abstract
HYPOTHESIS Implementation of Accreditation Council for Graduate Medical Education (ACGME) duty hour standards has had limited effects on resident training in otolaryngology. STUDY DESIGN Retrospective survey of residents and residency program directors (PDs). METHODS Surveys were mailed to residents and PDs in otolaryngology asking about compliance with ACGME duty hour standards and perceptions of changes brought on by the new regulations. RESULTS : Surveys were returned by 53.5% of PDs and 29.9% of residents. A majority of PDs described changes made to achieve compliance as "minor;" this consisted most commonly of altering call structure, although some programs hired new support staff or faculty. Mean estimated costs for changes were $14,211. Residents reported working a mean of 67.5 hours per week. Among PDs and residents, only 60% to 70% reported always being in compliance with the main components of the duty hour standards. Residents were largely divided in their opinions as to whether the duty hour limits had led to improvements in patient care, resident education, fatigue, or errors, although most felt that improvement in resident morale had occurred. PDs were more negative because almost half disagreed that improvement had occurred in any of these areas. CONCLUSIONS Compliance with ACGME duty hour standards remains challenging in otolaryngology. Neither residents nor PDs agree that implementation of the duty hour standards has led to the intended improvements in patient care or resident education, although most agree that resident morale has improved. Further study of objective patient care and educational outcome measures is indicated to validate the need for this change in residency training.
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Affiliation(s)
- Evan R Reiter
- Department of Otolaryngology-Head and Neck Surgery, VA Commonwealth University Health System, Richmond, Virginia, USA.
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