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Melariri H, Freercks R, van der Merwe E, Ham-Baloyi WT, Oyedele O, Murphy RA, Claasen C, Etusim PE, Achebe MO, Offiah S, Melariri PE. The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102571. [PMID: 38606166 PMCID: PMC11007440 DOI: 10.1016/j.eclinm.2024.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Background Hospital-acquired infections (HAI) are a leading cause of morbidity and mortality globally. These infections are diverse, but the majority are lower respiratory tract infection (LRTI), surgical site infection (SSI), bloodstream infection (BSI), and urinary tract infection (UTI). For most sub-Saharan African countries, studies revealing the burden and impact of HAI are scarce, and few systematic reviews and meta-analysis have been attempted. We sought to fill this gap by reporting recent trends in HAI in sub-Saharan Africa (SSA) with attention to key patient populations, geographic variation, and associated mortality. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search of six electronic databases (Web of Science, Pubmed, APA PsycInfo, CINAHL, Embase, and the Cochrane Library) to identify studies assessing the prevalence of HAI in SSA countries. Studies published between 01 January 2014 and 31 December 2023 were included. We applied no language or publication restrictions. Record screening and data extractions were independently conducted by teams of two or more reviewers. Using the R software (version 4.3.1) meta and metafor packages, we calculated the pooled prevalence estimates from random-effect meta-analysis, and further explored sources of heterogeneity through subgroup analyses and meta-regression. This study is registered with PROSPERO, CRD42023433271. Findings Forty-one relevant studies were identified for analysis, consisting of 15 from West Africa (n = 2107), 12 from Southern Africa (n = 2963), 11 from East Africa (n = 2142), and 3 from Central Africa (n = 124). A total of 59.4% of the patient population were associated with paediatric admissions. The pooled prevalence of HAI was estimated at 12.9% (95% CI: 8.9-17.4; n = 7336; number of included estimates [k] = 41, p < 0.001). By subregions, the pooled current prevalence of HAI in the West Africa, Southern Africa, East Africa and Central Africa were estimated at 15.5% (95% CI: 8.3-24.4; n = 2107; k = 15), 6.5% (95% CI: 3.3-10.7; n = 2963; k = 12), 19.7% (95% CI: 10.8-30.5; n = 2142; k = 11) and 10.3% (95% CI: 1.1-27.0; n = 124; k = 3) of the patient populations respectively. We estimated mortality resulting from HAI in SSA at 22.2% (95% CI: 14.2-31.4; n = 1118; k = 9). Interpretation Our estimates reveal a high burden of HAI in SSA with significant heterogeneity between regions. Variations in HAI distribution highlight the need for infection prevention and surveillance strategies specifically tailored to enhance prevention and management with special focus on West and East Africa, as part of the broader global control effort. Funding No funding was received for this study.
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Affiliation(s)
- Herbert Melariri
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, South Africa
- School of Medicine, Nelson Mandela University, South Africa
| | - Robert Freercks
- School of Medicine, Nelson Mandela University, South Africa
- Division of Nephrology and Hypertension, Livingstone Tertiary Hospital, South Africa
| | - Elizabeth van der Merwe
- School of Medicine, Nelson Mandela University, South Africa
- Department of Adult Critical Care, Livingstone Tertiary Hospital, South Africa
| | | | - Opeoluwa Oyedele
- Department of Computing, Mathematical and Statistical Sciences, University of Namibia, Namibia
- Department of Environmental Health, Nelson Mandela University, South Africa
| | - Richard A. Murphy
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Paschal Emeka Etusim
- Unit of Public Health/Environmental Parasitology and Entomology, Abia State University, Uturu, Nigeria
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Weaver MD, Barger LK, Sullivan JP, Quan SF, Robbins R, Landrigan CP, Czeisler CA. Public opinion of resident physician work hours in 2022. Sleep Health 2024; 10:S194-S200. [PMID: 37940477 DOI: 10.1016/j.sleh.2023.08.016] [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: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize public awareness and opinion regarding resident physician work hours in the United States. METHODS We conducted a nationally representative cross-sectional survey among adults in the United States. Demographic quota-based sampling was conducted by Qualtrics to match 2020 United States Census estimates of age, sex, race, and ethnicity. Descriptive statistics are presented. Hypothesis testing was conducted to identify characteristics associated with agreement with current resident physician work-hour policies. RESULTS 4763 adults in the United States participated in the study. 97.1% of the public believes that resident physicians should not work 24-hour shifts and 95.6% believe the current 80 hours resident work week is too long. 66.4% of the participants reported that the maximum shift duration should be 12 consecutive hours or fewer, including 22.9% who recommended a maximum shift length of 8 hours. Similarly, 66.4% reported that maximum weekly work hours should be 59 or fewer, including 24.9% who recommended a maximum of 40 weekly work hours. CONCLUSIONS Nearly all US adults disagree with current work-hour policies for resident physicians. Public opinion supports limiting shifts to no more than 12 consecutive hours and weekly work to no more than 60 hours, which is in sharp contrast to current regulations that permit of 28 hours shifts and 80 hours of work per week.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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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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Browne TK, Lederman Z. Incentivising civility in clinical environments. JOURNAL OF MEDICAL ETHICS 2023; 49:683-684. [PMID: 37433664 DOI: 10.1136/jme-2023-109231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Tamara Kayali Browne
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Practical and Public Ethics Research Group, Faculty of Arts, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Zohar Lederman
- Medical Ethics and Humanities Unit, Hong Kong University, Hong Kong, Hong Kong
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Yuan JH, Huang Y, Rosgen BK, Donnelly S, Lan X, Katz SJ. Burnout and fatigue amongst internal medicine residents: A cross-sectional study on the impact of alternative scheduling models on resident wellness. PLoS One 2023; 18:e0291457. [PMID: 37708198 PMCID: PMC10501672 DOI: 10.1371/journal.pone.0291457] [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: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Fatigue and burnout are prevalent among resident physicians across Canada. Shifts exceeding 24 hours are commonly purported as detrimental to resident health and performance. Residency training programs have employed strategies towards understanding and intervening upon the complex issue of resident fatigue, where alternative resident scheduling models have been an area of active investigation. This study sought to characterize drivers and outcomes of fatigue and burnout amongst internal medicine residents across different scheduling models. METHODS We conducted cross-sectional surveys were among internal medicine resident physicians at the University of Alberta. We collected anonymized socioeconomic demographics and medical education background, and estimated associations between demographic or work characteristics and fatigue and burnout outcomes. RESULTS Sixty-nine participants competed burnout questionnaires, and 165 fatigue questionnaires were completed (response rate of 48%). The overall prevalence of burnout was 58%. Lower burnout prevalence was noted among respondents with dependent(s) (p = 0.048), who identified as a racial minority (p = 0.018), or completed their medical degree internationally (p = 0.006). The 1-in-4 model was associated with the highest levels of fatigue, reported increased risk towards personal health (OR 4.98, 95%CI 1.77-13.99) and occupational or household harm (OR 5.69, 95%CI 1.87-17.3). Alternative scheduling models were not associated with these hazards. CONCLUSIONS The 1-in-4 scheduling model was associated with high rates of resident physician fatigue, and alternative scheduling models were associated with less fatigue. Protective factors against fatigue are best characterized as strong social supports outside the workplace. Further studies are needed to characterize the impacts of alternative scheduling models on resident education and patient safety.
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Affiliation(s)
- Jack H. Yuan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yiming Huang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brianna K. Rosgen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Donnelly
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoyang Lan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J. Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Rotenstein LS, Brown R, Sinsky C, Linzer M. The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19. J Gen Intern Med 2023; 38:1920-1927. [PMID: 36959522 PMCID: PMC10035977 DOI: 10.1007/s11606-023-08153-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types. OBJECTIVE To characterize the association of work overload with rates of burnout and intent to leave (ITL) the job in a large national sample of healthcare workers. DESIGN Cross-sectional survey study conducted between April and December 2020. SETTING A total of 206 large healthcare organizations. PARTICIPANTS Physicians, nurses, other clinical staff, and non-clinical staff. MEASURES Work overload, burnout, and ITL. RESULTS The sample of 43,026 respondents (mean response rate 44%) was comprised of 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. The overall burnout rate was 49.9% (56.0% in nursing, 54.1% in other clinical staff, 47.3% in physicians, and 45.6% in non-clinical staff; p < 0.001 for difference). ITL was reported by 28.7% of healthcare workers, with nurses most likely to report ITL (41.0%), followed by non-clinical staff (32.6%), other clinical staff (32.1%), and physicians (24.3%) (p < 0.001 for difference). The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. In propensity-weighted models, work overload was significantly associated with burnout (adjusted risk ratio (ARR) 2.21 to 2.90) and intent to leave (ARR 1.73 to 2.10) across role types. LIMITATIONS Organizations' participation in the survey was voluntary. CONCLUSIONS There are high rates of burnout and intent to leave the job across healthcare roles. Proactively addressing work overload across multiple role types may help with concerning trends across the healthcare workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all healthcare workers.
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Affiliation(s)
- Lisa S Rotenstein
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Roger Brown
- University of Wisconsin School of Nursing, Madison, USA
| | | | - Mark Linzer
- Hennepin Healthcare and the University of Minnesota, Minneapolis, USA
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Steffey MA, Risselada M, Scharf VF, Buote NJ, Zamprogno H, Winter AL, Griffon D. A narrative review of the impact of work hours and insufficient rest on job performance. Vet Surg 2023; 52:491-504. [PMID: 36802073 DOI: 10.1111/vsu.13943] [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: 10/22/2022] [Revised: 12/13/2022] [Accepted: 01/25/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN Narrative review. METHODS Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT) A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Valery F Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Nicole J Buote
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | | | | | - Dominique Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, California, USA
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Czeisler CA, Weaver MD, Landrigan CP, Berenberg W, Barger LK. Extended work hours increase risk of harm, regardless of resident physicians' experience levels. BMJ 2023; 381:838. [PMID: 37055060 DOI: 10.1136/bmj.p838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Vogt RL, Heck PR, Mestechkin RM, Heydari P, Chabris CF, Meyer MN. Experiment aversion among clinicians and the public - an obstacle to evidence-based medicine and public health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.05.23288189. [PMID: 37066423 PMCID: PMC10104223 DOI: 10.1101/2023.04.05.23288189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Randomized controlled trials (RCTs) are essential for determining the safety and efficacy of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either of two interventions for everyone rather than comparing them to determine which is best. We studied whether clinician and layperson views of pragmatic RCTs for Covid-19 or other interventions became more positive early in the pandemic, which increased both the urgency and public discussion of RCTs. Methods We conducted several survey studies with laypeople (total n=2,909) and two with clinicians (n=895; n=1,254) in 2020 and 2021. Participants read vignettes in which a hypothetical decision-maker who sought to improve health could choose to implement intervention A for all, implement intervention B for all, or experimentally compare A and B and implement the superior intervention. Participants rated and ranked the appropriateness of each decision. Results Compared to our pre-pandemic results, we found no decrease in laypeople's aversion to non-Covid-19 experiments involving catheterization checklists and hypertension drugs. Nor were either laypeople or clinicians less averse to Covid-19 RCTs (concerning corticosteroid drugs, vaccines, intubation checklists, proning, school reopening, and mask protocols), on average. Across all vignettes and samples, levels of experiment aversion ranged from 28% to 57%, while levels of experiment appreciation (in which the RCT is rated higher than the participant's highest-rated intervention) ranged from only 6% to 35%. Conclusions Advancing evidence-based medicine through pragmatic RCTs will require anticipating and addressing experiment aversion among both patients and healthcare professionals.
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Affiliation(s)
- Randi L. Vogt
- Department of Bioethics & Decision Sciences, Geisinger
| | | | | | - Pedram Heydari
- Department of Bioethics & Decision Sciences, Geisinger
- Department of Economics, University of Pittsburgh
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Zhang D, Gu D, Rao C, Zhang H, Su X, Chen S, Ma H, Zhao Y, Feng W, Sun H, Zheng Z. Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study. BMJ Qual Saf 2023; 32:192-201. [PMID: 35649696 DOI: 10.1136/bmjqs-2021-014244] [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: 09/14/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND With increasing surgical workload, it is common for cardiac surgeons to perform coronary artery bypass grafting (CABG) after other procedures in a workday. To investigate whether prior procedures performed by the surgeon impact the outcomes, we compared the outcomes between CABGs performed first versus those performed after prior procedures, separately for on-pump and off-pump CABGs as they differed in technical complexity. METHODS We conducted a retrospective cohort study of patients undergoing isolated CABG in China from January 2013 to December 2018. Patients were categorised as undergoing on-pump and off-pump CABGs. Outcomes of the procedures performed first in primary surgeons' daily schedule (first procedure) were compared with subsequent ones (non-first procedure). The primary outcome was an adverse events composite (AEC) defined as the number of adverse events, including in-hospital mortality, myocardial infarction, stroke, acute kidney injury and reoperation. Secondary outcomes were the individual components of the primary outcome, presented as binary variables. Mixed-effects models were used, adjusting for patient and surgeon-level characteristics and year of surgery. RESULTS Among 21 866 patients, 10 109 (16.1% as non-first) underwent on-pump and 11 757 (29.6% as non-first) off-pump CABG. In the on-pump cohort, there was no significant association between procedure order and the outcomes (all p>0.05). In the off-pump cohort, non-first procedures were associated with an increased number of AEC (adjusted rate ratio 1.29, 95% CI 1.13 to 1.47, p<0.001), myocardial infarction (adjusted OR (ORadj) 1.43, 95% CI 1.13 to 1.81, p=0.003) and stroke (ORadj 1.73, 95% CI 1.18 to 2.53, p=0.005) compared with first procedures. These increases were only found to be statistically significant when the procedure was performed by surgeons with <20 years' practice or surgeons with a preindex volume <700 cases. CONCLUSIONS For a technically challenging surgical procedure like off-pump CABG, prior workload adversely affected patient outcomes.
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Affiliation(s)
- Danwei Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dachuan Gu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoting Su
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hanping Ma
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hansong Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
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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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12
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Barger LK, Weaver MD, Sullivan JP, Qadri S, Landrigan CP, Czeisler CA. Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study. BMJ MEDICINE 2023; 2:e000320. [PMID: 37303489 PMCID: PMC10254593 DOI: 10.1136/bmjmed-2022-000320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/15/2023] [Indexed: 06/13/2023]
Abstract
Objective To determine whether long weekly work hours and shifts of extended duration (≥24 hours) are associated with adverse patient and physician safety outcomes in more senior resident physicians (postgraduate year 2 and above; PGY2+). Design Nationwide, prospective cohort study. Setting United States, conducted over eight academic years (2002-07, 2014-17). Participants 4826 PGY2+ resident physicians who completed 38 702 monthly web based reports of their work hours and patient and resident safety outcomes. Main outcome measures Patient safety outcomes included medical errors, preventable adverse events, and fatal preventable adverse events. Resident physician health and safety outcomes included motor vehicle crashes, near miss crashes, occupational exposures to potentially contaminated blood or other bodily fluids, percutaneous injuries, and attentional failures. Data were analysed with mixed effects regression models that accounted for dependence of repeated measures and controlled for potential confounders. Results Working more than 48 hours per week was associated with an increased risk of self-reported medical errors, preventable adverse events, and fatal preventable adverse events as well as near miss crashes, occupational exposures, percutaneous injuries, and attentional failures (all P<0.001). Working between 60 and 70 hours per week was associated with a more than twice the risk of a medical error (odds ratio 2.36, 95% confidence interval 2.01 to 2.78) and almost three times the risk of preventable adverse events (2.93, 2.04 to 4.23) and fatal preventable adverse events (2.75, 1.23 to 6.12). Working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours was associated with an 84% increased risk of medical errors (1.84, 1.66 to 2.03), a 51% increased risk of preventable adverse events (1.51, 1.20 to 1.90), and an 85% increased risk of fatal preventable adverse events (1.85, 1.05 to 3.26). Similarly, working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours also increased the risk of near miss crashes (1.47, 1.32 to 1.63) and occupational exposures (1.17, 1.02 to 1.33). Conclusions These results indicate that exceeding 48 weekly work hours or working shifts of extended duration endangers even experienced (ie, PGY2+) resident physicians and their patients. These data suggest that regulatory bodies in the US and elsewhere should consider lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
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Affiliation(s)
- Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Sephien A, Reljic T, Jordan J, Prida X, Kumar A. Resident duty hours and resident and patient outcomes: Systematic review and meta-analysis. MEDICAL EDUCATION 2023; 57:221-232. [PMID: 36181404 DOI: 10.1111/medu.14943] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The policies regarding resident physician work hours are constantly being evaluated and changed. However, the results of randomised control trials (RCTs) are mixed. This systematic review of RCTs aims to synthesise the evidence associated with resident duty hour restrictions and its impact on resident- and patient-based outcomes. METHODS A comprehensive search of the Cochrane Library, EMBASE and PubMed was conducted from inception until 31 July 2020. Any RCT evaluating the impact of longer resident physician work hours compared to shorter resident physician work hours on resident- and patient-based outcomes was eligible for inclusion. Two reviewers extracted data independently. The primary outcome was the impact of resident duty hour restrictions on emotional exhaustion, depersonalisation and personal accomplishment, as defined by the Maslach Burnout Inventory. The secondary patient-related outcomes were patient hospital length of stay, serious medical errors and preventable adverse events. Data were pooled using a random-effects model. RESULTS Of the 873 references, nine RCTs met the inclusion criteria. A shorter shift length compared with longer shift length was associated with significantly less emotional exhaustion (standardised mean difference [SMD] = -0.11, 95% CI = -0.21, -0.00) and less dissatisfaction with overall well-being (OR = 0.61, 95% CI 0.38, 0.99) but not with hospital length of stay (SMD = -0.01, 95% CI = -0.05, 0.02, p = 0.45) and serious medical errors per 1000 patient hours (OR = 1.07, 95% CI = 0.52, 2.21; p = 0.86). CONCLUSIONS Shorter resident duty hours is possibly associated with improvement in resident-based outcomes, specifically, emotional exhaustion, dissatisfaction with overall well-being, sleep duration and sleepiness. These findings may inform the policy change in support of reduced shift hours resulting in overall well-being for the residents with possible reduction in burnout without adverse impact on patient-based outcomes.
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Affiliation(s)
- Andrew Sephien
- Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida, USA
| | - Tea Reljic
- Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Jeffrey Jordan
- Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida, USA
| | - Xavier Prida
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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14
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Hwang J, Kelz R. Impact of medical education on patient safety: finding the signal through the noise. BMJ Qual Saf 2023; 32:61-64. [PMID: 36113985 DOI: 10.1136/bmjqs-2022-015054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Jasmine Hwang
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Kelz
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Czeisler CA, Barger LK. National improvements in resident physician-reported patient safety after limiting first-year resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies. BMJ Qual Saf 2023; 32:81-89. [PMID: 35537821 PMCID: PMC9887355 DOI: 10.1136/bmjqs-2021-014375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This was rescinded in 2017. METHODS We conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002-2007) before and for 3 academic years (2014-2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Our analyses compare trends in resident physician-reported medical errors between the two cohorts to evaluate the impact of this policy change. RESULTS 14 796 residents provided data describing 78 101 months of direct patient care. After adjustment for potential confounders, the work-hour policy was associated with a 32% reduced risk of resident physician-reported significant medical errors (rate ratio (RR) 0.68; 95% CI 0.64 to 0.72), a 34% reduced risk of reported preventable adverse events (RR 0.66; 95% CI 0.59 to 0.74) and a 63% reduced risk of reported medical errors resulting in patient death (RR 0.37; 95% CI 0.28 to 0.49). CONCLUSIONS These findings have broad relevance for those who work in and receive care from academic hospitals in the USA. The decision to lift this work hour policy in 2017 may expose patients to preventable harm.
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Affiliation(s)
- Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Medicine, and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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16
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Ishikawa M. Overwork among resident physicians: national questionnaire survey results. BMC MEDICAL EDUCATION 2022; 22:729. [PMID: 36266644 PMCID: PMC9584270 DOI: 10.1186/s12909-022-03789-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Residents experience the longest working hours among physicians. Thus, it would be beneficial to perform a nationwide survey in Japan on residents' long work hours and the background factors promoting upper limits on working hours of Japanese residents. The aim of this study was to study or assess the state of physicians' excessive work hours and its background factors using a questionnaire survey. METHODS The survey was sent to 924 hospitals. The physicians' general attributes, work hours and conditions, and employers' foundational entities were explored. Multiple logistic regression analysis was performed to elucidate the background factors for long work hours. RESULTS Of the 4306 resident physicians who responded, 67% had ≥ 60 in-hospital hours/week and 27% had ≥ 80 h/week; 51% were on-call ≥ four times/month. Many of them hoped for increased remuneration. Additionally, female (reference: male, OR: 0.65, 95% CI: 0.55-0.76), 35-40 years old (reference: 25-30 years old, OR: 1.83, 95% CI: 1.32-2.54), childlessness (reference: child, OR: 1.41, 95% CI: 1.12-1.75), surgical specialization (reference: internal medicine, OR: 2.51, 95% CI: 1.96-3.23), neurosurgical specialization (reference: internal medicine, OR: 4.38, 95% CI: 2.92-6.59) and hospitals with 200-400 physicians (reference: <100 physicians, OR: 1.82, 95% CI: 1.12-2.96) exhibited significant correlations with ≥ 80 in-hospital hours/week. CONCLUSION Understanding the factors that increase the likelihood of residents working very long hours could aid in making targeted changes to address the specific concerns. Moreover, reducing working hours to a reasonable limit can improve resident physicians' health and the quality of care they provide in their community.
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Affiliation(s)
- Masatoshi Ishikawa
- Faculty of Medicine, University of Tsukuba, 1 Chome-1-1 Tennodai, 305-8577, Tsukuba, Ibaraki, Japan.
- Research Institute, Tokyo Healthcare University, Shinagawa, Tokyo, Japan.
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17
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Dehmoobad Sharifabadi A, Clarkin C, Doja A. Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums. BMJ Open 2022; 12:e063104. [PMID: 36167374 PMCID: PMC9516167 DOI: 10.1136/bmjopen-2022-063104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Resident duty hour (RDH) restrictions in postgraduate medical education is a controversial yet important topic for study. There is limited literature on authentic trainee perceptions surrounding RDH restrictions to inform evaluation and future planning. Online forums are a widely accessible, yet underused resource, for insight into trainee perceptions. Our objective was to qualitatively assess trainee perceptions of RDH restrictions on online discussion forums. SETTING Online discussion forums; Premed101 (Canadian forum) and Student Doctor Network (SDN) (American forum). PARTICIPANTS 6630 posts from 161 discussion threads; comprising 429 posts in 14 threads from Premed101 and 6201 posts in 147 threads from SDN. Posters included medical students, residents and attending physicians. DESIGN Data were analysed inductively and iteratively to create themes and subthemes. Cocoding, consensus-based decision making and an audit trail were used to ensure trustworthiness. RESULTS Key findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties and the inter-relationship between fatigue and patient safety. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations were also featured on the American SDN forum. CONCLUSIONS The findings of this study reveal multiple themes pertinent to the implementation and revision of RDH restrictions. The most prominent theme was the inapplicability of blanket restrictions on duty hours theme due to the diversity of training needs across specialties and the environmental context of training programmes. Other discussions included the inter-relationship of patient safety and resident competence with duty hours. Lastly, concerns regarding the lack of transparency and psychological safety surrounding RDH violations, were discussed.
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Affiliation(s)
| | - Chantalle Clarkin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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18
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Salgado SM, Katz JT, Pelletier SR, Goodberlet M, Kelly J, Duperreault M, Ali NB, Shields HM. Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes. J Patient Saf 2022; 18:e938-e946. [PMID: 35152234 PMCID: PMC9422754 DOI: 10.1097/pts.0000000000000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical interdisciplinary teams. METHODS Sixty-two interns, 27 residents, 28 attendings, and 449 patients participated. Patients completed surveys assessing their satisfaction. Anonymous weekly surveys were obtained from interns, residents, and attendings evaluating perceptions of intern tiredness, overall satisfaction, and performance. Nursing surveys evaluated intern and medical team performance. Objective outcome measures, including intensive care unit transfers, length of stay, readmissions, mortality, and complications, were assessed through a retrospective, blinded chart review. RESULTS Patients reported similar satisfaction in care. Extended duty-hour interns reported significantly decreased familiarity with their patients, decreased ability to conduct physical exams on new patients, increased tiredness, and decreased overall satisfaction. Residents overseeing extended-duty interns reported significantly decreased quality in intern presentations and overall quality of teaching, and increased perception of intern tiredness and increased incorrect orders. Attending physicians reported significantly improved quality of new patient presentations by extended duty-hour interns. No significant differences in patient objective outcome measures were noted. CONCLUSIONS Extended intern duty hours do not affect patient's satisfaction with their care. Although interns in the extended duty-hour system reported significantly increased fatigue and decreased overall satisfaction and residents' perceived increases in incorrect intern orders in the extended duty-hour system, there were no detrimental effects on patient safety.
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Affiliation(s)
- Sanjay M. Salgado
- From the Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel T. Katz
- Department of Medicine, Brigham and Women’s Hospital
- Harvard Medical School
| | | | | | - Julie Kelly
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston
| | - Megan Duperreault
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston
| | - Nadaa B. Ali
- Harvard Medical School
- Primary Care, Atrius Health, Wellesley, Massachusetts
| | - Helen M. Shields
- Department of Medicine, Brigham and Women’s Hospital
- Harvard Medical School
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19
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Shimazu Y, Kobashi Y, Imoto S, Tsubokura M. A retrospective observational study analyzing work and study motivation based on the work environment of 15,677 Japanese clinicians in 2016. Sci Rep 2022; 12:14806. [PMID: 36045145 PMCID: PMC9428877 DOI: 10.1038/s41598-022-19007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Physicians play an active role in public health. However, there is a limit to the knowledge and experience that can be gained through hospital work alone. This was a secondary data analysis from 100,000 doctors in Japan (15,677 respondents). The results of the analysis showed that 898 (8.4%) male and 190 (6.0%) female doctors worked 60 h or more in a week. The percentage of physicians whose spouse was a physician was found to be 31.4% (male) and 61.7% (female) (p < 0.001), and the rate of full-time working clinicians was 85.7% (male) and 30.0% (female) (p < 0.001). In the univariate analysis, female’s working hours were affected by childbirth and childcare experience (p < 0.001, 95% CI − 10.3 to − 8.4, with “none” as reference) and specialty certification (p < 0.001, 95% CI − 3.5 to − 1.4, with “none” as reference). In the multivariate analysis, physician’s working hours were associated with sex (coefficient, − 7.4; 95% CI − 8.3 to − 6.5, with “male as reference), childbirth/childcare (coefficient, − 2.2; 95% CI − 2.9 to − 1.4, with “possession” as reference), and specialty qualification (coefficient − 4.0, 95% CI − 5.0 to − 3.0, with “possession” as reference). To summarize the results of the analysis, work/study motivation of physicians will be facilitated by ensuring adequate learning opportunities and by developing support systems and environments.
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Affiliation(s)
- Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan.
| | - Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan
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20
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Lee S, Kim YS, Park K, Lee M, Jang JY. Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery. Yonsei Med J 2022; 63:751-758. [PMID: 35914757 PMCID: PMC9344275 DOI: 10.3349/ymj.2022.63.8.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery. MATERIALS AND METHODS A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation. RESULTS The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). CONCLUSION The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients' clinical outcomes.
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Affiliation(s)
- Sungho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yeon Su Kim
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Kwanhoon Park
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - MiWoo Lee
- Department of Social Welfare, Hanyang Woman's University, Seoul, Korea
| | - Ji Young Jang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Schwab Jensen K, Sherman AE, Wang T, Melamed K. A Prospective Trial of an In-house Overnight Fellow Rotation in the Intensive Care Unit. ATS Sch 2022; 3:301-311. [PMID: 37881337 PMCID: PMC10594893 DOI: 10.34197/ats-scholar.2022-0012oc] [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] [Received: 01/27/2022] [Accepted: 04/27/2022] [Indexed: 10/27/2023] Open
Abstract
Background Although previous studies in academic intensive care units (ICUs) have found no improvement in patient care outcomes with in-house overnight attending physician coverage compared with home call coverage, the effect of in-house supervision on trainee education and well-being is less clear. In addition, no studies have examined the effect of in-house coverage by fellow physicians overnight. Objective What is the impact of an in-house overnight critical care fellow on resident, fellow, and attending perception of patient safety, house staff education, and house staff well-being? Methods A prospective trial alternating 2-week periods of in-house overnight critical care fellow coverage with 2-week periods of home call coverage was performed in our tertiary medical ICU. Residents, fellows, and attendings were surveyed to evaluate perceptions of the night fellows' impact on patient care, communication, supervision, educational experience, autonomy, well-being, and job satisfaction. Results Over the 6-month study period, surveys were sent to 83 residents, 22 fellows, and 23 attendings, with completion by 56 (67%), 22 (100%), and 16 (70%), respectively. Overall, 89% of residents, 68% of fellows, and 81% of attendings reported perceived improvements in patient care with an in-house fellow. The in-house fellow was also associated with improved well-being in 79% of residents and 73% of fellows, and 82% of residents felt that it positively impacted education. Conclusion As compared with the traditional home call system, an in-house night critical care fellow can improve the perception of patient care, trainee well-being, and education in a tertiary ICU at an academic hospital.
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Affiliation(s)
| | | | - Tisha Wang
- Division of Pulmonary and Critical Care Medicine, David Geffen School of
Medicine at the University of California, Los Angeles, Los Angeles,
California
| | - Kathryn Melamed
- Division of Pulmonary and Critical Care Medicine, David Geffen School of
Medicine at the University of California, Los Angeles, Los Angeles,
California
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22
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Gold CA, Scott BJ, Weng Y, Bernier E, Kvam KA. Outcomes of a Neurohospitalist Program at an Academic Medical Center. Neurohospitalist 2022; 12:453-462. [DOI: 10.1177/19418744221083182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose The purpose is to determine the impact of an academic neurohospitalist service on clinical outcomes. Methods We performed a retrospective, quasi-experimental study of patients discharged from the general neurology service before (August 2010–July 2014) and after implementation of a full-time neurohospitalist service (August 2016–July 2018) compared to a control group of stroke patients. Primary outcomes were length of stay and 30-day readmission. Using the difference-in-difference approach, the impact of introducing a neurohospitalist service compared to controls was assessed with adjustment of patients’ characteristics. Secondary outcomes included mortality, in-hospital complications, and cost. Results There were 2706 neurology admissions (1648 general; 1058 stroke) over the study period. The neurohospitalist service was associated with a trend in reduced 30-day readmissions (ratio of ORs: .52 [.27, .98], P = .088), while length of stay was not incrementally changed in the difference-in-difference model (-.3 [-.7, .1], P = .18). However, descriptive results demonstrated a significant reduction in mean adjusted LOS of .7 days (4.5 to 3.8 days, P < .001) and a trend toward reduced readmissions (8.9% to 7.6%, P = .42) in the post-neurohospitalist cohort despite a significant increase in patient complexity, shift to higher acuity diagnoses, more emergent admissions, and near quadrupling of observation status patients. Mortality and in-hospital complications remained low, patient satisfaction was stable, and cost was not incrementally changed in the post-neurohospitalist cohort. Conclusions Implementation of a neurohospitalist service at an academic medical center is feasible and associated with a significant increase in patient complexity and acuity and a trend toward reduced readmissions.
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Affiliation(s)
- Carl A. Gold
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Brian J. Scott
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Yingjie Weng
- Stanford University, Quantitative Sciences Unit, Stanford, CA, USA
| | | | - Kathryn A. Kvam
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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Mookerjee A, Li B, Arora B, Surapaneni R, Rajput V, Van de Ridder M. Micromanagement During Clinical Supervision: Solutions to the Challenges. Cureus 2022; 14:e23523. [PMID: 35495010 PMCID: PMC9038605 DOI: 10.7759/cureus.23523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
Abstract
Learner autonomy is an invaluable asset in graduate medical education, preparing the trainee to independently face challenges in the future professional settings. Educational institutions face the difficult task of providing a balance between learner autonomy and supervision. In graduate medical education, trainees often prefer less supervision than what is imparted by their attending physician. This increased supervision comes at the cost of learner autonomy and has not exhibited improvement in patient outcomes or safety. When attendings exhibit control over details, the trainees may label them as “micromanagers”. Cardinal features of a micromanager include excessively requesting updates, insisting that the task be done their way, and scrutinizing every detail. This micromanaging behavior is non-conducive to the learning environment and may even contribute to supervisor burnout. The business literature reveals a debate about this very topic. Unfortunately, there is still a lack of literature on micromanagement in graduate medical education. Although a conglomerate of internal factors may lead to excessive supervision in an academic medical institution, we surmise that micromanagement exists because of a complex dynamic between three drivers: accountability, trust, and autonomy. When trainees are held accountable, they learn to take ownership for their actions which leads to establishment of trust which further enables motivation and gaining of autonomy. Supervising attendings should ideally be able to comfortably adjust their level of supervision based on their trust and the trainee’s competence, accountability, and autonomy. The micromanaging physician is unable to do so, and this can have a detrimental effect on the learner. Micromanagement can be perceived by some as a beneficial component during the early immersion of the trainee with the rationalization for better patient outcomes and safety. However, in the long term, it threatens the learning environment and erodes the complex relationship between accountability, trust, and autonomy. We recommend an action plan to mitigate micromanagement at three levels-the micromanager, the micromanaged, and the organizational structure-and hope that these solutions enhance the learning environment for both the trainee and supervisor.
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Ishikawa M. Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: a nationwide questionnaire-based survey. BMJ Open 2022; 12:e056283. [PMID: 35273058 PMCID: PMC8915267 DOI: 10.1136/bmjopen-2021-056283] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan. DESIGN A nationwide, questionnaire-based survey. SETTING Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020. PARTICIPANTS Valid responses were obtained from 4306 physicians (response rate: 49%). OUTCOME MEASURES Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables. RESULTS Regarding the Japanese Burnout Scale, the highest score was recorded for 'sense of personal accomplishment', followed by 'emotional exhaustion' and 'depersonalization'. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds (reference: <200 beds, OR: 0.23, 95% CI: 0.07 to 0.82). CONCLUSIONS Many Japanese residents demonstrated a tendency to experience burnout and suicidal ideation. Female sex, low income, long working hours and insufficient hospital beds were associated with suicidal ideation. To ensure physicians' health and patients' safety, it is necessary to advance workstyle reform for physicians.
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Affiliation(s)
- Masatoshi Ishikawa
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Tokyo Healthcare University, Gotanda, Tokyo, Japan
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Ishikawa M. Factors associated with overwork among pediatricians at Japanese hospitals. Pediatr Int 2022; 64:e15173. [PMID: 35727869 DOI: 10.1111/ped.15173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the global health issue of doctors working excessive hours, working practices for doctors in Japan are currently undergoing reform. We aimed to ascertain the actual situation of excessive working hours among pediatricians and factors influencing these conditions in Japan. METHODS Pediatricians employed at hospitals throughout Japan completed a questionnaire regarding their current working situation, including the time spent at the hospital and whether their working environment had improved since 2018, when the reform of doctors' working practices began. Multiple logistic regression analysis was performed to identify background factors associated with excessive working hours. RESULTS Questionnaires were sent to 848 Japanese hospitals that submitted insurance reimbursement claims for pediatric inpatient treatment. Valid responses were received from 1,539 pediatricians at 416 hospitals (49% response rate). Of these pediatricians, 51.7% spent ≥60 h/week at their hospital, 14.4% spent ≥80 h/week, and 47.4% worked nights at least four times a month. Compared with 2018, 8.8% and 35.4% responded that their working environment had greatly or somewhat improved, respectively. Working for ≤60 h/week was considered appropriate by 81.9% of pediatricians. Background factors associated with spending ≥80 h/week at the hospital were male sex, age <30 years, lack of children, specialty of pediatric cardiology, annual income exceeding ¥16 million, employment at a private university hospital, and employment at a hospital with a comparatively large number of pediatricians. CONCLUSIONS This study clarified the background factors and the actual situation of the long working hours among pediatricians working in Japanese hospitals.
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Affiliation(s)
- Masatoshi Ishikawa
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Research Institute, Tokyo Heathcare University, Gotanda, Tokyo, Japan
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Klitzman RL. Understanding Ethical Challenges in Medical Education Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:18-21. [PMID: 34292193 DOI: 10.1097/acm.0000000000004253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Rapidly advancing biomedical and electronic technologies, ongoing health disparities, and new online educational modalities are all changing medicine and medical education. As medical training continues to evolve, research is increasingly critical to help improve it, but medical education research can pose unique ethical challenges. As research participants, medical trainees may face several risks and in many ways constitute a vulnerable group. In this commentary, the author examines several of the ethical challenges involved in medical education research, including confidentiality and the risk of stigma; the need for equity, diversity, and inclusion; genetic testing of students; clustered randomized trials of training programs; and questions about quality improvement activities. The author offers guidance for navigating these ethical challenges, including the importance of engaging with institutional review boards. Academic medical institutions should educate and work closely with faculty to ensure that all research adheres to appropriate ethical guidelines and regulations and should provide instruction about the ethics of medical education research to establish a strong foundation for the future of the field. Research on medical education will become increasingly important. Given the potential sensitivity of the data collected in such research, investigators must understand and address potential ethical challenges as carefully as possible.
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Affiliation(s)
- Robert L Klitzman
- R.L. Klitzman is professor of psychiatry and director, Masters of Bioethics Program, Columbia University, New York, New York
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Nakao H, Nomura O, Kubota M, Ishiguro A. Long-term impact of overnight shiftwork implementation on pediatric residents' mental wellness: A repeated cross-sectional survey. J Occup Health 2022; 64:e12349. [PMID: 35906714 PMCID: PMC9338226 DOI: 10.1002/1348-9585.12349] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/25/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The Japanese government partially enacted the “Work Style Reform Bill” in 2019. The National Center for Child Health and Development (NCCHD) introduced an Overnight Call Shift (OCS) system for pediatrician training. We conducted a follow‐up survey in 2019 to investigate the long‐term effectiveness of the OCS system to improve the pediatric residents' mental wellness at NCCHD. Methods We conducted a questionnaire‐based cross‐sectional survey for pediatric residents in 2019 to compare the data with those of the previous survey in 2012. The questionnaire includes demographic data, working conditions data, and mental wellness assessment by the Center for Epidemiologic Studies Depression scale (CES‐D) and the Maslach Burnout Inventory (MBI). Results The collection rate for the 2019 survey was 94.5% (37 participants/39 eligible). Compared to 2012, there were no significant changes in demographic data and working hours, a significant increase by about 30% in residents who took daytime off after night work, about 10% decrease in residents who scored 16 and above on the CES‐D, and a significant decrease in the mean score for depersonalization (DP) in the MBI. Multiple regression analyses showed that daytime off after night work was the decreasing factor for CES‐D and Emotional exhaustion (EE). Conclusions The overnight shiftwork system shortened the pediatric residents' duty hours somewhat, and imposed an impact on the pediatric residents' mental wellness.
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Affiliation(s)
- Hiro Nakao
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Osamu Nomura
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
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Owei L, Luks VL, Brooks KD, Kelz RR, Berns JS, Aarons CB. Smart-phone Based Geofencing: A Novel Approach to Monitoring Clinical Work Hours in Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2021; 78:e210-e217. [PMID: 34294568 DOI: 10.1016/j.jsurg.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education specifies strict requirements for clinical work hours during residency training, with serious consequences for violations. Self-reporting of work hours by trainees can be inaccurate due to recall bias, giving program directors limited data to influence change. We aimed to assess the impact of a smart-phone based geofencing application on submission rates for work hours and reported violations in a general surgery residency program at a university-based medical center. We also examined resident perceptions surrounding implementation and use of the application. METHODS We compared clinical work hours submitted and violations reported during the pilot period (October-November 2019) with the months prior to the launch of the application (July-August 2019). PGY1 and PGY2 residents were eligible to use the application during and after this pilot period. Semi-structured interviews were used to assess resident perceptions. A retrospective review was conducted to compare reporting during the same time period from the prior academic year (2018-2019) for historical reference. Paired t-tests were used to analyze the data. RESULTS Twenty-six residents (15 PGY1, 11 PGY2) were eligible for the intervention and 23 residents (88%) used the application. The mean number of violations reported decreased significantly during the pilot period compared with the months prior to the intervention (4.5 vs. 11, p = 0.04). The total rate of submissions was not significantly different after the intervention (85% vs. 82%, p = 0.42). The PGY1 mean submission rate decreased during the pilot period (91%-75%, p = 0.21) while the PGY2 submission rate increased (77%-91%, p = 0.07). Compared with historical data, there was an increase in overall total submission rates between academic years 2018/2019 and 2019/2020 (74% vs. 79%, p = 0.047) and an associated decrease in the mean number of monthly violations (14 vs. 6.25, p = 0.004). Thirteen (50%) residents (8 PGY1, 5 PGY2) volunteered for semi-structured interviews. Most participants found the application useful for recording and reporting clinical work hours. They noted an ease in the administrative burden as well as more accurate reporting associated with automated logging. Use of the application was not perceived to limit engagement with patient care; however, there were privacy concerns and some technical barriers were identified. The messaging regarding the application's use was identified as critical for implementation. CONCLUSIONS The "real-time" data provided by a geofencing application in our program helped to reduce the number of work-hour violations reported and did not diminish resident engagement with patient care. Decreasing the administrative burden of recording work hours coupled with improving transparency and accuracy of submissions may be important mechanisms.
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Affiliation(s)
- Lily Owei
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Valerie L Luks
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kendall D Brooks
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Berns
- Department of Medicine, Division of Nephrology, and Office of Graduate Medical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Amabile A, Mori M, Brooks C, Weininger G, Shang M, Fereydooni S, Komlo CM, Mullan CW, Hameed I, Geirsson A. The impact of trainees' working hour regulations on outcome in CABG and valve surgery in the State of New York. J Card Surg 2021; 36:4582-4590. [PMID: 34617327 DOI: 10.1111/jocs.16058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted the first-year residents' duty-hour to less than 16-hour shifts, decreased the maximum shift duration for senior residents, and increased minimum time off after on-call duties. Whether these changes may have impacted the outcomes in cardiac surgery remains unclear. METHODS We performed a difference-in-difference analysis of the New York State Cardiac Surgery Reporting System data in 2004-2006 (before the duty-hour policies change) and 2014-2016 (after the change). We evaluated differences in 30-day risk-adjusted mortality rates (RAMR) in coronary artery bypass grafting (CABG) and valve surgeries, stratifying data by hospital type: teaching hospitals (TH) versus nonteaching hospitals (NTH). NTH served as the control not affected by the duty-hour policies. RESULTS (1) The overall surgical volume for CABG surgery has decreased over time (37,645-24,991), while the volume for valve surgery remained similar (20,969-21,532); (2) TH had better short-term outcomes for CABG procedures during 2014-2016 (median RAMR: 1.01% vs. 1.55% in TH vs. NTH, respectively; p = .025) as well as for valve procedures during both 2004-2006 (5.16% vs. 7.49%, p = .020) and 2014-2016 (2.59% vs. 4.09%, p = .033); (3) at difference-in-difference analysis, trainees' duty-hour regulations were not associated with worsening short-term outcomes in both CABG (p = .296) and valve (p = .651) procedures performed in TH. CONCLUSION The introduction of the 2011 trainees' duty-hour regulations was not associated with worse short-term outcomes for CABG and valve surgery performed in the State of NY by TH.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Makoto Mori
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cornell Brooks
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gabe Weininger
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Shang
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Soraya Fereydooni
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline M Komlo
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Clancy W Mullan
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Cordoza M, Basner M, Asch DA, Shea JA, Bellini LM, Carlin M, Ecker AJ, Malone SK, Desai SV, Katz JT, Bates DW, Small DS, Volpp KG, Mott CG, Coats S, Mollicone DJ, Dinges DF. Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial. J Grad Med Educ 2021; 13:717-721. [PMID: 34721802 PMCID: PMC8527933 DOI: 10.4300/jgme-d-21-00045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. OBJECTIVE To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. METHODS This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. RESULTS Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). CONCLUSIONS Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
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Affiliation(s)
- Makayla Cordoza
- Makayla Cordoza, PhD, RN, CCRN-K*, is a Lecturer, University of Pennsylvania
| | - Mathias Basner
- Mathias Basner, MD, PhD, MSc*, is a Professor, University of Pennsylvania
| | - David A. Asch
- David A. Asch, MD, MBA, is a Professor, University of Pennsylvania, and Practicing Physician, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Judy A. Shea
- Judy A. Shea, PhD, is a Professor, University of Pennsylvania
| | - Lisa M. Bellini
- Lisa M. Bellini, MD, is a Professor, University of Pennsylvania
| | - Michele Carlin
- Michele Carlin is a Project Manager, University of Pennsylvania
| | - Adrian J. Ecker
- Adrian J. Ecker is a Senior IT Project Leader, University of Pennsylvania
| | - Susan K. Malone
- Susan K. Malone, PhD, RN, is an Assistant Professor, New York University
| | - Sanjay V. Desai
- Sanjay V. Desai, MD, is a Professor, Johns Hopkins University
| | - Joel T. Katz
- Joel T. Katz, MD, is Vice Chair for Education, Brigham and Women's Hospital
| | - David W. Bates
- David W. Bates, MD, MSc, is Division of General Internal Medicine Chief, Brigham and Women's Hospital
| | - Dylan S. Small
- Dylan S. Small, PhD, is a Professor, University of Pennsylvania
| | - Kevin G. Volpp
- Kevin G. Volpp, MD, PhD, is a Professor, University of Pennsylvania, and Practicing Physician, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | | | - Sara Coats
- Sara Coats, BS, is Lead Project Coordinator, Pulsar Informatics
| | | | - David F. Dinges
- David F. Dinges, PhD, is a Professor, University of Pennsylvania; and iCOMPARE Research Group
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In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs. Crit Care Med 2021; 48:e1203-e1210. [PMID: 33031147 DOI: 10.1097/ccm.0000000000004598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Overnight physician staffing in the ICU has been recommended by the Society of Critical Care Medicine and the Leapfrog Consortium. We conducted a survey to review practice in the current era and to compare this with results from a 2006 survey. DESIGN Cross-sectional survey. SETTING Canadian adult ICUs. PARTICIPANTS ICU directors. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS A 29-question survey was sent to ICU directors describing overnight staffing by residents, fellows, nurse practitioners, and staff physicians, as well as duty duration, clinical responsibilities, and unit characteristics. We established contact with 122 ICU directors, of whom 107 (88%) responded. Of the 107 units, 60 (56%) had overnight in-house physicians. Compared with ICUs without overnight in-house physician coverage, ICUs with in-house physicians were in larger hospitals (p < 0.0001), had more beds (p < 0.0001), had more ventilated patients (p < 0.0001), and had more admissions (p < 0.0001). Overnight in-house physicians were first year residents (R1) in 20 of 60 (33%), second to fifth year residents (R2-R5) in 46 of 60 (77%), and Critical Care Medicine trainees in 19 of 60 (32%). Advanced practice nurses provided overnight coverage in four of 107 ICUs (4%). The most senior in-house physician was a staff physician in 12 of 60 ICUs (20%), a Critical Care Medicine trainee in 14 of 60 (23%), and a resident (R2-R5) in 20 of 60 (33%). The duration of overnight duty was on average 20-24 hours in 22 of 46 units (48%) with R2-R5 residents and 14 of 19 units (74%) covered by Critical Care Medicine trainees. CONCLUSIONS Variability of in-house overnight physician presence in Canadian adult ICUs is linked to therapeutic complexity and unit characteristics and has not changed significantly over the decade since our 2006 survey. Additional evidence about patient and resident outcomes would better inform decisions to revise physician scheduling in Canadian ICUs.
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Sun H, Chen D, Warner DO, Zhou Y, Nemergut EC, Macario A, Keegan MT. Anesthesiology Residents' Experiences and Perspectives of Residency Training. Anesth Analg 2021; 132:1120-1128. [PMID: 33438965 DOI: 10.1213/ane.0000000000005316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiology residents' experiences and perspectives about their programs may be helpful in improving training. The goals of this repeated cross-sectional survey study are to determine: (1) the most important factors residents consider in choosing an anesthesiology residency, (2) the aspects of the clinical base year that best prepare residents for anesthesia clinical training, and what could be improved, (3) whether residents are satisfied with their anesthesiology residency and what their primary struggles are, and (4) whether residents believe their residency prepares them for proficiency in the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and for independent practice. METHODS Anesthesiologists beginning their US residency training from 2013 to 2016 were invited to participate in anonymous, confidential, and voluntary self-administered online surveys. Resident cohort was defined by clinical anesthesia year 1, such that 9 survey administrations were included in this study-3 surveys for the 2013 and 2014 cohorts (clinical anesthesia years 1-3), 2 surveys for the 2015 cohort (clinical anesthesia years 1-2), and 1 survey for the 2016 cohort (clinical anesthesia year 1). RESULTS The overall response rate was 36% (4707 responses to 12,929 invitations). On a 5-point Likert scale with 1 as "very unimportant" and 5 as "very important," quality of clinical experience (4.7-4.8 among the cohorts) and departmental commitment to education (4.3-4.5) were rated as the most important factors in anesthesiologists' choice of residency. Approximately 70% of first- and second-year residents agreed that their clinical base year prepared them well for anesthesiology residency, particularly clinical training experiences in critical care rotations, anesthesiology rotations, and surgery rotations/perioperative procedure management. Overall, residents were satisfied with their choice of anesthesiology specialty (4.4-4.5 on a 5-point scale among cohort-training levels) and their residency programs (4.0-4.1). The residency training experiences mostly met their expectations (3.8-4.0). Senior residents who reported any struggles highlighted academic more than interpersonal or technical difficulties. Senior residents generally agreed that the residency adequately prepared them for independent practice (4.1-4.4). Of the 6 ACGME Core Competencies, residents had the highest confidence in professionalism (4.7-4.9) and interpersonal and communication skills (4.6-4.8). Areas in residency that could be improved include the provision of an appropriate balance between education and service and allowance for sufficient time off to search and interview for a postresidency position. CONCLUSIONS Anesthesiology residents in the United States indicated they most value quality of clinical training experiences and are generally satisfied with their choice of specialty and residency program.
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Affiliation(s)
- Huaping Sun
- From the American Board of Anesthesiology, Raleigh, North Carolina
| | - Dandan Chen
- From the American Board of Anesthesiology, Raleigh, North Carolina
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester Minnesota
| | - Yan Zhou
- From the American Board of Anesthesiology, Raleigh, North Carolina
| | - Edward C Nemergut
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester Minnesota
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Potisek NM, D'Alessandro DM, Huber JN, Wolbrink TA, Lockspeiser TM, Fromme HB, Ryan MS. An Annotated Bibliography of Key Studies in Medical Education in 2019: Applying the Current Literature to Educational Practice and Scholarship. Acad Pediatr 2021; 21:425-434. [PMID: 33524623 DOI: 10.1016/j.acap.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/31/2022]
Abstract
Pediatric medical educators have the dual challenge of remaining up-to-date in the field of pediatrics and in the field of medical education. Due to the volume of information published in these 2 fields it can be nearly impossible to remain current in both fields of practice. To facilitate interpretation of the most recent medical education research, the authors conducted an annotated bibliography of medical education literature published in 2019. The purpose of this annotated bibliography was to identify manuscripts which had the potential to significantly influence a pediatric educator's practice. Using a 2-staged review process, the authors reviewed abstracts from 13 medical education and specialty journals. All reviews were independently completed by 2 different reviewers for each journal in both stages. A total of 4700 abstracts were reviewed and 17 key manuscripts were identified. The authors grouped the key manuscripts into 6 core themes: bedside teaching, learning climate, bias, learner autonomy, learner in trouble, and resident competency. This annotated bibliography provides the authors' condensed summary of the medical education manuscripts most likely to influence educational practices for the busy pediatric medical educator.
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Affiliation(s)
- Nicholas M Potisek
- Prisma Health Children's Hospital, University of South Carolina School of Medicine (NM Potisek), Greenville, SC; Department of Pediatrics, Wake Forest School of Medicine and Brenner Children's Hospital (NM Potisek), Winston-Salem, NC.
| | | | - Jody N Huber
- Department of Pediatrics, University of South Dakota Sanford School of Medicine (JN Huber), Sioux Falls, SD
| | - Traci A Wolbrink
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (TA Wolbrink), Boston, Mass
| | - Tai M Lockspeiser
- Department of Pediatrics, University of Colorado, School of Medicine (TM Lockspeiser), Aurora, Colo
| | - H Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine (HB Fromme), Chicago, Ill
| | - Michael S Ryan
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University School of Medicine (MS Ryan), Richmond, Va
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Dairo Oguntebi A, Rosenbluth G. Doctors Also Need Sleep: Is It Time to Take Another Look at Our ROSTERS? Pediatrics 2021; 147:peds.2020-034017. [PMID: 33619045 DOI: 10.1542/peds.2020-034017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Abimbola Dairo Oguntebi
- Department of Pediatric Hospital Medicine, Santa Clara Medical Center, Kaiser Permanente, Santa Clara, California; and
| | - Glenn Rosenbluth
- Division of Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Rahman SA, Sullivan JP, Barger LK, St. Hilaire MA, O’Brien CS, Stone KL, Phillips AJ, Klerman EB, Qadri S, Wright KP, Halbower AC, Segar JL, McGuire JK, Vitiello MV, de la Iglesia HO, Poynter SE, Yu PL, Sanderson AL, Zee PC, Landrigan CP, Czeisler CA, Lockley SW. Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians. Pediatrics 2021; 147:peds.2020-009936. [PMID: 33619044 PMCID: PMC7919117 DOI: 10.1542/peds.2020-009936] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Extended-duration work rosters (EDWRs) with shifts of 24+ hours impair performance compared with rapid cycling work rosters (RCWRs) that limit shifts to 16 hours in postgraduate year (PGY) 1 resident-physicians. We examined the impact of a RCWR on PGY 2 and PGY 3 resident-physicians. METHODS Data from 294 resident-physicians were analyzed from a multicenter clinical trial of 6 US PICUs. Resident-physicians worked 4-week EDWRs with shifts of 24+ hours every third or fourth shift, or an RCWR in which most shifts were ≤16 consecutive hours. Participants completed a daily sleep and work log and the 10-minute Psychomotor Vigilance Task and Karolinska Sleepiness Scale 2 to 5 times per shift approximately once per week as operational demands allowed. RESULTS Overall, the mean (± SE) number of attentional failures was significantly higher (P =.01) on the EDWR (6.8 ± 1.0) compared with RCWR (2.9 ± 0.7). Reaction time and subjective alertness were also significantly higher, by ∼18% and ∼9%, respectively (both P <.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (P =.04). Although a higher rate of SMEs was observed under the RCWR, after adjusting for workload, RCWR had a protective effect on the rate of SMEs (rate ratio 0.48 [95% confidence interval: 0.30-0.77]). CONCLUSIONS Performance impairment due to EDWR is improved by limiting shift duration. These data and their correlation with SME rates highlight the impairment of neurobehavioral performance due to extended-duration shifts and have important implications for patient safety.
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Affiliation(s)
- Shadab A. Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jason P. Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Melissa A. St. Hilaire
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Conor S. O’Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Andrew J.K. Phillips
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Elizabeth B. Klerman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kenneth P. Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Ann C. Halbower
- Department of Pediatrics, Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Jeffrey L. Segar
- University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa
| | | | | | | | - Sue E. Poynter
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Pearl L. Yu
- University of Virginia Children’s Hospital, Charlottesville, Virginia
| | - Amy L. Sanderson
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine and
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher P. Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Steven W. Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts;,Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
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Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians. NPJ Digit Med 2021; 4:28. [PMID: 33603132 PMCID: PMC7892862 DOI: 10.1038/s41746-021-00400-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/11/2021] [Indexed: 01/31/2023] Open
Abstract
While 24-h total sleep time (TST) is established as a critical driver of major depression, the relationships between sleep timing and regularity and mental health remain poorly characterized because most studies have relied on either self-report assessments or traditional objective sleep measurements restricted to cross-sectional time frames and small cohorts. To address this gap, we assessed sleep with a wearable device, daily mood with a smartphone application and depression through the 9-item Patient Health Questionnaire (PHQ-9) over the demanding first year of physician training (internship). In 2115 interns, reduced TST (b = -0.11, p < 0.001), later bedtime (b = 0.068, p = 0.015), along with increased variability in TST (b = 0.4, p = 0.0012) and in wake time (b = 0.081, p = 0.005) were associated with more depressive symptoms. Overall, the aggregated impact of sleep variability parameters and of mean sleep parameters on PHQ-9 were similar in magnitude (both r2 = 0.01). Within individuals, increased TST (b = 0.06, p < 0.001), later wake time (b = 0.09, p < 0.001), earlier bedtime (b = - 0.07, p < 0.001), as well as lower day-to-day shifts in TST (b = -0.011, p < 0.001) and in wake time (b = -0.004, p < 0.001) were associated with improved next-day mood. Variability in sleep parameters substantially impacted mood and depression, similar in magnitude to the mean levels of sleep parameters. Interventions that target sleep consistency, along with sleep duration, hold promise to improve mental health.
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Affiliation(s)
- Benjamin L Mazer
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
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Gupta A, Houchens N. Quality & Safety in the Literature: January 2021. BMJ Qual Saf 2020; 30:83-88. [PMID: 33154109 DOI: 10.1136/bmjqs-2020-012602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
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Finn KM, Halvorsen AJ, Chaudhry S, Desai S, Dupras D, Reddy S, Wahi-Gururaj S, Willett L, Zaas AK. Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements. J Gen Intern Med 2020; 35:3205-3209. [PMID: 32869195 PMCID: PMC7661583 DOI: 10.1007/s11606-020-06109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multi-center randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. OBJECTIVE We sought to determine program directors' (PDs) support for the work hour changes and programmatic response. DESIGN In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions. KEY RESULTS The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38-58, 13/69 [19%]; 59-100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%). CONCLUSIONS Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs' decisions to change trainee schedules.
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Affiliation(s)
- Kathleen M Finn
- Internal Medicine Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andrew J Halvorsen
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saima Chaudhry
- Office of Academic Affairs, Memorial Healthcare System, Hollywood, FL, USA
| | - Sanjay Desai
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Denise Dupras
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shalini Reddy
- Internal Medicine Residency Program, John H. Stroger Hospital of Cook County Health, Chicago, IL, USA
| | - Sandhya Wahi-Gururaj
- Internal Medicine Residency, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Lisa Willett
- Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee K Zaas
- Internal Medicine Residency Program, Duke University School of Medicine, Durham, NC, USA
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An Online Curriculum in the PICU-Do You Have Plans Tonight? Pediatr Crit Care Med 2020; 21:1005-1006. [PMID: 33136988 DOI: 10.1097/pcc.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fukami T, Uemura M, Nagao Y. Doctors-in-training support strategy from incident report point of view. Ann Med Surg (Lond) 2020; 56:139-141. [PMID: 32637089 PMCID: PMC7327027 DOI: 10.1016/j.amsu.2020.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tatsuya Fukami
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Masakazu Uemura
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Yoshimasa Nagao
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health. Am J Med 2020; 133:e343-e354. [PMID: 32061733 PMCID: PMC7469904 DOI: 10.1016/j.amjmed.2019.12.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. METHODS All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. RESULTS Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. CONCLUSIONS The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass.
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Department of Medicine, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Department of Integrative Physiology, University of Colorado, Boulder
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
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Landrigan CP, Rahman SA, Sullivan JP, Vittinghoff E, Barger LK, Sanderson AL, Wright KP, O'Brien CS, Qadri S, St Hilaire MA, Halbower AC, Segar JL, McGuire JK, Vitiello MV, de la Iglesia HO, Poynter SE, Yu PL, Zee PC, Lockley SW, Stone KL, Czeisler CA. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts. N Engl J Med 2020; 382:2514-2523. [PMID: 32579812 PMCID: PMC7405505 DOI: 10.1056/nejmoa1900669] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial. METHODS We conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that included shifts of 24 hours or more (control schedules) and schedules that eliminated extended shifts and cycled resident physicians through day and night shifts of 16 hours or less (intervention schedules). The primary outcome was serious medical errors made by resident physicians, assessed by intensive surveillance, including direct observation and chart review. RESULTS The characteristics of ICU patients during the two work schedules were similar, but resident physician workload, described as the mean (±SD) number of ICU patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2). Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P<0.001). The number of serious errors unitwide were likewise higher during the intervention schedules (181.3 vs. 131.5 per 1000 patient-days; relative risk, 1.56; 95% CI, 1.43 to 1.71). There was wide variability among sites, however; errors were lower during intervention schedules than during control schedules at one site, rates were similar during the two schedules at two sites, and rates were higher during intervention schedules than during control schedules at three sites. In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors. CONCLUSIONS Contrary to our hypothesis, resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site. The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts. (Funded by the National Heart, Lung, and Blood Institute; ROSTERS ClinicalTrials.gov number, NCT02134847.).
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Affiliation(s)
- Christopher P Landrigan
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Shadab A Rahman
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Jason P Sullivan
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Eric Vittinghoff
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Laura K Barger
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Amy L Sanderson
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Kenneth P Wright
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Conor S O'Brien
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Salim Qadri
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Melissa A St Hilaire
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Ann C Halbower
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Jeffrey L Segar
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - John K McGuire
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Michael V Vitiello
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Horacio O de la Iglesia
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Sue E Poynter
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Pearl L Yu
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Phyllis C Zee
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Steven W Lockley
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Katie L Stone
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Charles A Czeisler
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
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Moffatt-Bruce SD, Kneuertz P. Commentary: The very real generation gap: Times are a-changing. J Thorac Cardiovasc Surg 2020; 162:343-344. [PMID: 32475497 PMCID: PMC7172828 DOI: 10.1016/j.jtcvs.2020.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Peter Kneuertz
- Department of Surgery, The Ohio State University, Columbus, Ohio
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Sfez M, Salaün JP, Villevieille T, Baghdadi H, Raucoules-Aimé M. How far can we go with resident duty hours? Anaesth Crit Care Pain Med 2020; 39:5-6. [PMID: 31911142 DOI: 10.1016/j.accpm.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michel Sfez
- Clinique Oudinot, 2, rue Rousselet, 75007 Paris, France; Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France.
| | - Jean-Philippe Salaün
- CHU de Caen, Department of Anaesthesiology and Critical Care Medicine, Caen University Hospital, avenue de la Côte de Nacre, 14033 Caen, France; Juniors group (Groupe Jeunes) of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Thierry Villevieille
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Franco-British Hospital, 4, rue Kléber, 92300 Levallois-Perret, France
| | - Houtin Baghdadi
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Anaesthesia service, Aix-en-Provence Hospital, avenue des Tamaris, 13616 Aix-en-Provence, France
| | - Marc Raucoules-Aimé
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Department of Anaesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, voie Romaine, CS 51069, 06001, Nice cedex 1, France
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Ellis L. Artificial intelligence for precision education in radiology - experiences in radiology teaching from a UK foundation doctor. Br J Radiol 2019; 92:20190779. [PMID: 31646896 PMCID: PMC6913361 DOI: 10.1259/bjr.20190779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Liddy Ellis
- Pinewood Education Centre, Stepping Hill Hospital, Poplar Grove, Hazel Grove, Stockport, SK2 7JE, UK
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Berry AC, McClain EK. Response. J Osteopath Med 2019; 119:644a-645. [DOI: 10.7556/jaoa.2019.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Jeremy Samuel Faust
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Houchens N, Meddings J, Gupta A. Quality and safety in the literature: September 2019. BMJ Qual Saf 2019; 28:769-774. [PMID: 31253735 DOI: 10.1136/bmjqs-2019-009918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Jennifer Meddings
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States.,Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
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