The effect of a full shift system on doctors

A qualitative investigation of Foundation Year 2 doctors' views on the European Working Time Directive

PURPOSE - The purpose of this paper is to examine the personal views and experiences of Foundation Year 2 doctors operating under the European Working Time Directive (EWTD). DESIGN/METHODOLOGY/APPROACH - In total, 36 Foundation Year 2 doctors from a single UK-based Deanery participated in this semistructured interview study. FINDINGS - Findings indicated that Foundation doctors typically welcomed a regulation of working hours, but reported frustration at the manner in which the Directive had been implemented. Participants reported concerns at reducing hours by removing out-of-hours working in order to meet EWTD requirements. Out-of-hours shifts were highly valued owing to their increased opportunities for autonomous clinical decision making. By contrast, day-shifts were regarded as heavily administrative in nature and were perceived as service provision. Foundation doctors discussed the unique nature of the out-of-hours working period which appeared to provide specific learning opportunities as doctors draw on time management and prioritisation skills. ORIGINALITY/VALUE - Given the challenges the EWTD presents, careful rota planning is essential. First, the authors would encourage the restructuring of day-shift work to provide a greater emphasis on hands-on skills experience in a supportive, supervised environment. Second, where possible, Foundation doctors might benefit from the opportunity to engage in some out-of-hours working, such as with multi-professional "Hospital at Night" teams. Third, the authors would encourage junior doctor involvement in rota design and planning which may increase their perceived autonomy and therefore buy-in of working practices.

Conceptual frameworks in the study of duty hours changes in graduate medical education: a review

PURPOSE

Conceptual frameworks are approaches to a research problem that specify key entities and their relationships. The 2009 Institute of Medicine (IOM) report on resident duty hours, subsequent studies, and published responses to the report present a variety of conceptual frameworks for the study of the impact of duty hours regulations. The authors sought to identify and describe these conceptual frameworks and their implications.

METHOD

The authors reviewed the IOM report and articles in both peer-reviewed and non-peer-reviewed literature for the period January 2008 through April 2010, identified using multiple electronic databases including PubMed, EMBASE, CINAHL, BEME, and PsycInfo. Studies that explicitly described or argued for the effect of resident duty hours on any other outcome, as judged by consensus of multiple reviewers, were included. The authors selected 239 of 858 studies reviewed. Several of the authors reviewed articles to identify conceptual frameworks used implicitly or explicitly to describe the relationship between duty hours (or duty hours regulations) and outcomes. Identification was by consensus.

RESULTS

Twenty-three conceptual frameworks were identified. Several made contradictory predictions about the impact of duty hours regulations on patient outcomes, resident education, and other key outcomes.

CONCLUSIONS

The concept of duty hours itself is contested, and little attention has been paid to the nature and intensity of the activities that occupy residents' hours. Much research focuses on isolated outcomes of duty hours changes without considering mediation or moderation. More studies are needed to define trade-offs between outcomes and the value society places on these trade-offs.