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Han ER, Chung EK. A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea. PLoS One 2024; 19:e0301502. [PMID: 38603669 PMCID: PMC11008864 DOI: 10.1371/journal.pone.0301502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.
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Affiliation(s)
- Eui-Ryoung Han
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun-Kyung Chung
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
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Bowden SG, Siler DA, Shahin MN, Mazur-Hart DJ, Munger DN, Ross MN, O’Neill BE, Nerison CS, Rothbaum M, Han SJ, Wright JM, Orina JN, Winer JL, Selden NR. Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.5.focus22181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems.
METHODS
The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020. The authors analyzed the volumes of new patient consultations, bedside procedures, and operative procedures performed by each PGY-2 and PGY-3 resident during these years, comparing the volumes experienced under each call system.
RESULTS
Changing from a PGY-2 resident–focused night-float call system to a 24-hour call system that was more evenly distributed between PGY-2 and PGY-3 residents resulted in decreased volume of new patient consultations, increased volume of operative procedures, and no change in volume of bedside procedures for PGY-2 residents. PGY-3 residents experienced a decrease in operative procedure volume under the 24-hour call system.
CONCLUSIONS
Transition from a night-float system to a 24-hour call system altered the distribution of clinical and procedural experiences between PGY-2 and PGY-3 residents. Further research is necessary to understand the impact of these changes on educational outcomes, quality and safety of patient care, and resident satisfaction.
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Affiliation(s)
- Stephen G. Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Dominic A. Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Maryam N. Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Daniel N. Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Miner N. Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Brannan E. O’Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Caleb S. Nerison
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Seunggu J. Han
- Department of Neurosurgery, Stanford University, Palo Alto, California
| | - James M. Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Josiah N. Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Jesse L. Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Nathan R. Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
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Katz SJ. Staff and resident perceptions on the introduction of a team based multi-specialty resident night shift system. PLoS One 2022; 17:e0268569. [PMID: 35588439 PMCID: PMC9119506 DOI: 10.1371/journal.pone.0268569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/03/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To determine the perceptions of staff and resident physicians on the impact of implementation of a new team based multi-specialty resident night shift system.
Methods
An electronic survey was distributed anonymously to all resident physicians in the Core Internal Medicine residency program at the University of Alberta. A similar survey was distributed to staff physicians in the 4 specialties impacted by this new system: hematology, respirology, nephrology and gastroenterology.
Results
74 physicians completed the survey. A majority of respondents (67%) indicated the new system was a positive change. Most shared it was better than traditional 1 in 4 call (65%), with resident physicians appreciating the team based nature of the system (65%), and just more than half of residents (55%) indicating this system improved their overall wellness. Most respondents (78%) did not feel the additional handover required had a negative impact. Respondents indicated daytime teaching and feedback improved as a result of this system (52%) with most others indicating it had no impact, although overnight feedback remained a challenge.
Conclusion
The implementation of this new team based system was well accepted by both staff and resident physicians across a number of domains. Future study is required to determine its impact on access and quality of care.
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Affiliation(s)
- Steven J. Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Chapman KD, Badami V, Stawovy L, Ali S, Abdelfattah M. Transition to an In-House Night Float System for Critical Care Fellows: Resident Experience, Morbidity, and Mortality in a Rural Academic Hospital. Cureus 2021; 13:e17200. [PMID: 34540428 PMCID: PMC8439410 DOI: 10.7759/cureus.17200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background In-house night call systems for ICUs are frequently implemented to enable hands-on patient care and provide direct supervision of resident physicians at night. Previous studies have highlighted the benefits of an in-house night float (NF) such as minimized time to intervention but failed to consistently demonstrate an improvement in patient outcomes. This study aimed to evaluate the impact of an in-house critical care fellow at night on the resident experience and assess for impact on patient morbidity and mortality. Methods An in-house overnight critical care fellow shift was implemented at West Virginia University Hospital in 2018. Resident physicians rotating overnight in the medical ICU (MICU) for six-month periods before and after the intervention were anonymously surveyed. A retrospective chart review of 300 patients admitted overnight to the MICU was performed. Multiple patient outcomes from the pre (2017) and post (2018) intervention periods were collected and compared using a two-sample t-test. Results In the post-intervention survey, nearly every element of resident experience improved (availability of support, comfort in performing invasive procedures, and input in treatment plans), and far fewer residents felt overwhelmed relative to the pre-intervention survey. The resident experience markedly improved with the addition of an in-house critical care fellow. For the retrospective chart review, both groups had similar severity of illness and there was no change in ICU or hospital length of stay. No difference in mortality was found, though the study was underpowered for this outcome. For secondary measures, there was no difference in mechanical ventilation or use days, though more procedures performed were overnight compared to the former staffing model. Conclusions Implementation of an in-house overnight critical care fellow shift in the MICU positively impacted resident experience without worsening patient outcomes. The intervention did not worsen measures of morbidity or mortality but did lead to an increased number of procedures performed overnight. The model of in-house NF coverage continues to be preferred by clinicians.
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Affiliation(s)
- Kyle D Chapman
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Varun Badami
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Lauren Stawovy
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Sana Ali
- Medicine/Pulmonary and Critical Care, Albany Medical Center, Albany, USA
| | - Mohamad Abdelfattah
- Medicine/Pulmonary and Critical Care, Martin Luther King, Jr. Community Hospital, Los Angeles, USA
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Hamill CS, Cabrera CI, Murthy H, Mowry S, Maronian N, Tamaki A. Initiation of a Night Float System in an Otolaryngology Residency: Resident Perception and Impact on Operative Volume. Laryngoscope 2021; 131:2211-2218. [PMID: 33797075 DOI: 10.1002/lary.29541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Evaluate resident perception on implementation of a night float (NF) system to an otolaryngology residency program. We compared these perceptions to Accreditation Council for Graduate Medical Education (ACGME) case log data. METHODS A retrospective anonymous survey was sent to residents and alumni graduating between 2015 and 2023. Deidentified ACGME case log information was then examined for key indicator (KI) cases from post graduate year (PGY) 2 and PGY5. RESULTS Thirty (93.8%) residents and alumni responded. Residents with NF answered more positively compared to those without NF on following duty hour violations: 80-hour work week, 1-in-7 days off, 1 call every 3 days, adequate time between shifts, and allotted time after a 24-hour shift. Residents most commonly agreed that NF has improved patient care, resident education, and resident morale. Although residents with NF were neutral on PGY2 case volume effects, they disagreed that it affected overall case volume. The only KIs that differed for both PGY2 and PGY5s were airway cases (P = .004 vs P = .002) and bronchoscopy (P = .02 vs P = .006), which were significantly higher for those with NF. Thyroid surgery was the only KI higher for the residents without NF and spanned all PGY levels. CONCLUSION Residents and alumni agreed that NF implementation had a positive effect on duty hour violations. The NF system does not have significant impact on case volume. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Henna Murthy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Sarah Mowry
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Huber JN, Olgun G, Whalen LD, Sandeen AR, Rana DT, Zenel JA. Learner Preference of Schedule Type Improves Engagement of Pediatric Residents: Results of a Mixed-Methods Analysis. MEDICAL SCIENCE EDUCATOR 2020; 30:1551-1559. [PMID: 34457823 PMCID: PMC8368307 DOI: 10.1007/s40670-020-01036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Determine whether a call or shift schedule is better for acquiring optimal knowledge and professionalism, while limiting fatigue for pediatric residents during the pediatric intensive care unit (PICU) rotation in a small residency program. METHODS This was a prospective, randomized, crossover, mixed-methods study in which pediatric residents were randomized to either a call or shift schedule during their PICU rotation. Attentiveness, bedside care, perceived knowledge, and professionalism were assessed by the resident participants, attending physicians, and nursing staff. Epworth Sleepiness Scale determined the level of resident fatigue. Statistical analysis utilized a t test of unequal variances. Two focus groups were conducted of resident non-participants and participants. Graduated resident participants and non-participants were surveyed via anonymous e-mail responses. RESULTS Thirty residents participated in the study and twenty residents were surveyed and participated in a focus group. No major differences were detected between each participating group, whether assigned to a call or shift schedule in regard to perceived knowledge, professionalism, or fatigue. Overall themes from qualitative analysis identified advantages and disadvantages for both work schedules. Participants recognized a learner preference for schedule type depending on level of training, suggesting a shift schedule for junior residents and a call schedule for senior residents. CONCLUSIONS There is no difference between the call or shift schedule in regard to residents' perceived knowledge, professionalism, and fatigue. Participants expressed learner preferences for one schedule over the other, recommending the shift schedule during the PGY-2 year and the call schedule during the PGY-3 year.
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Affiliation(s)
- Jody N. Huber
- Sanford Children’s Hospital, Sanford Medical Center, 1600 W 22nd St., Sioux Falls, SD 57117 USA
- University of South Dakota Sanford School of Medicine, E. Clark St., Vermillion, SD 57069 USA
| | - Gokhan Olgun
- Sanford Children’s Hospital, Sanford Medical Center, 1600 W 22nd St., Sioux Falls, SD 57117 USA
- University of South Dakota Sanford School of Medicine, E. Clark St., Vermillion, SD 57069 USA
| | - Lesta D. Whalen
- Sanford Children’s Hospital, Sanford Medical Center, 1600 W 22nd St., Sioux Falls, SD 57117 USA
- University of South Dakota Sanford School of Medicine, E. Clark St., Vermillion, SD 57069 USA
| | - Ashley R. Sandeen
- Sanford Children’s Hospital, Sanford Medical Center, 1600 W 22nd St., Sioux Falls, SD 57117 USA
- University of South Dakota Sanford School of Medicine, E. Clark St., Vermillion, SD 57069 USA
| | - Deborah T. Rana
- University of California San Diego School of Medicine, UCSD Center for Mindfulness, 5060 Shoreham Place, Suite 330, San Diego, CA 92122 USA
| | - Joseph A. Zenel
- Sanford Children’s Hospital, Sanford Medical Center, 1600 W 22nd St., Sioux Falls, SD 57117 USA
- University of South Dakota Sanford School of Medicine, E. Clark St., Vermillion, SD 57069 USA
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Yu HW, Choi JY, Park YS, Park HS, Choi Y, Ahn SH, Kang E, Oh HK, Kim EK, Cho JY, Kim DW, Park DJ, Yoon YS, Kang SB, Kim HH, Han HS, Lee T. Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey. Ann Surg Treat Res 2019; 96:209-215. [PMID: 31073510 PMCID: PMC6483933 DOI: 10.4174/astr.2019.96.5.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. Methods A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. Results A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. Conclusion This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
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Affiliation(s)
- Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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