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Mathur P, Halvorson S, Cywinski JB, Machado S, Khatib R, Kurz AM, Galway U, Mascha EJ. Timing of Intraoperative Transitions of Care Among Anesthesiologists Is Not Associated With Postoperative Adverse Outcomes: Retrospective Cohort Study. Anesth Analg 2024; 139:186-194. [PMID: 38885400 DOI: 10.1213/ane.0000000000006853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND The majority of published research suggests that anesthesia handovers during major surgical procedures are associated with unintended harmful consequences. It is still unclear if the number or quality of the transition of care is the main driver of the adverse outcomes. There is even less data if the timing of the anesthesiologist handovers during the critical portion of the anesthetic continuum (induction or emergence versus surgical period) plays a role in patient outcomes. Therefore, we investigated if the anesthesiologist handovers during induction and emergence are associated with adverse patient outcomes. METHODS This retrospective investigation included noncardiac surgical procedures occurring between January 1, 2012 and December 31, 2019 that had exactly 1 attending anesthesiologist handover. We categorized transitions of care between attending anesthesiologists as being before incision, between incision and closing, and after closing. Our primary outcome was a composite of 6 categories of surgical complications and in-hospital mortality. We created logistic generalized estimating equation models to estimate the average relative effect odds ratio between each pair of the 3 transition timing groups across the components of the composite outcome. Inverse probability of treatment weights were used to mitigate confounding on a host of baseline variables. We used Bonferroni correction to adjust for multiple comparisons between the transition groups. RESULTS In total, we studied 36,937 procedures with exactly 1 attending anesthesiologist handover. Of these records, 4370 had the transition during induction, 24,999 between incision and closure, and 7568 during emergence. No differences were found between the transition periods and the composite outcome. The estimated average relative effect odds ratio (98.3% confidence interval [CI]) across the components of the composite outcome was as follows: (1.0002 [0.81-1.24], P = .99) between the induction and surgical period; (1.10 [0.87-1.40], P = .32) between the induction and emergence periods; and (0.91 [0.79-1.04], P = .08) between the emergence and surgical periods. CONCLUSIONS Timing of intraoperative handover among attending anesthesiologists during noncardiac surgery is not associated with adverse patient outcomes.
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Affiliation(s)
- Piyush Mathur
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sven Halvorson
- Prevention Science Institute, University of Oregon, Oregon
| | - Jacek B Cywinski
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sandra Machado
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reem Khatib
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea M Kurz
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, University of Graz, Graz, Austria
| | - Ursula Galway
- From the Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward J Mascha
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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Han ER, Chung EK. A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea. PLoS One 2024; 19:e0301502. [PMID: 38603669 PMCID: PMC11008864 DOI: 10.1371/journal.pone.0301502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.
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Affiliation(s)
- Eui-Ryoung Han
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun-Kyung Chung
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
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Acker R, Swendiman RA, Luks VL, Hanna AN, Lee MK, Williams NN, Kelz RR, Lynn J, Aarons CB. Pulling Back from the Brink: A Multi-Pronged Approach to Address General Surgery Resident Clinical Work Hour Adherence. JOURNAL OF SURGICAL EDUCATION 2022; 79:e17-e24. [PMID: 35697656 DOI: 10.1016/j.jsurg.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The conflict between prioritizing education for surgical trainees, promoting trainee wellness, and maintaining optimal patient care has remained challenging since the introduction of the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions in 2003. There is still a dearth of research examining which interventions successfully enable duty hour adherence. This study assessed the impact of a combination of strategic interventions on improving clinical work hour adherence. METHODS Monthly clinical work hour submission rates were assessed for all general surgery residents at a single university-based residency program over a 3-year period (2018-2021). Interventions targeted 3 domains and were implemented between academic years 2018 to 2019 (control) and 2020 to 2021 (intervention): 1) improving the accuracy and transparency of work hour reporting, 2) facilitating more timely interventions, and 3) structural scheduling changes. All 80-hour work week and continuous work hour violations were assessed. Findings were also compared to the corresponding ACGME Resident Survey results. RESULTS There was no significant difference in the rate of monthly work hour submissions pre- and postintervention (78% vs 75%, p = 0.057). However, the number of total reported monthly violations decreased significantly (mean 13.8 vs 2.4, p < 0.01), including decreases in both 80-hour work week and continuous work hour violations (mean 4.7 vs 1.6, p < 0.001 and 9.1 vs 0.8, p < 0.001, respectively). Reported compliance also increased on the annual ACGME resident surveys, where 61% vs 95% of residents felt they were compliant with the 80-hour work week and 71% vs 95% felt they were compliant with the continuous work hours (2018-19 vs 2020-21). CONCLUSION Innovative strategies addressing schedule changes, the culture of work hour reporting, and early intervention significantly decreased the number of duty hour violations at our institution. Reported resident compliance also improved based on ACGME Resident Survey data. These data may inform similar multifaceted approaches at other institutions to improve overall work hour adherence.
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Affiliation(s)
- Rachael Acker
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Robert A Swendiman
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Valerie L Luks
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Andrew N Hanna
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Major Kenneth Lee
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny Lynn
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
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Redinger J, Kabil E, Forkin KT, Kleiman AM, Dunn LK. Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training. J Grad Med Educ 2022; 14:420-430. [PMID: 35991104 PMCID: PMC9380640 DOI: 10.4300/jgme-d-21-01035.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. OBJECTIVE To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. METHODS A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. RESULTS Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. CONCLUSIONS Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
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Affiliation(s)
- Joyce Redinger
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Joyce Redinger, MD, is PGY-3 Resident
| | - Emmad Kabil
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Emmad Kabil, MD, is PGY-4 Resident
| | - Katherine T. Forkin
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Katherine T. Forkin, MD, is Associate Professor of Anesthesiology
| | - Amanda M. Kleiman
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Amanda M. Kleiman, MD, is Associate Professor of Anesthesiology
| | - Lauren K. Dunn
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Lauren K. Dunn, MD, PhD, is Associate Professor of Anesthesiology and Neurological Surgery
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Huang Y, Alkhalfan F, Kim H, Alzedaneen Y, Haleem Z, Zhou M, Sood A, Chow RD. The Impact of Electronic Handoff Tool on Sign-Out Practices in an Internal Medicine Residency Program. Am J Med Qual 2022; 37:290-298. [PMID: 35213861 DOI: 10.1097/jmq.0000000000000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents' subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. CEX scores significantly improved from 5.3 ± 1.1 to 6.9 ± 0.7 in 6 weeks ( P < 0.05). Residents reported that they were contacted less frequently after work, information needed by the receiving resident was more often found in the sign-out, and that tasks signed out to the oncoming team were more often executed. Before implementing the new handoff tool, 87% of residents reported that they were contacted after work hours 1-2 times per week with questions, while 75% of participants reported that they were almost never contacted after work hours after the new tool was implemented. A standardized handoff tool that utilizes smart phrases to provide residents with templates for sign-out significantly improved the quality and experience of sign-out in a short time period.
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Affiliation(s)
- Yuting Huang
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Fahad Alkhalfan
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Harim Kim
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Yazan Alzedaneen
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Zarah Haleem
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | - Meng Zhou
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Aseem Sood
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Robert D Chow
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
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6
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Saleem HY, Kaplan JL, Torres-Guzman RA, Avila FR, Forte AJ. Simulation in Hand Surgery: A Literature Review. World J Surg 2022; 46:718-724. [PMID: 34993601 DOI: 10.1007/s00268-021-06400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to duty hour regulations, patient safety and inadequate operative time simulation have become a necessary part of surgical education and training in residency. Currently, there is no formal adoption of simulators for the use of surgical education or assessment in hand surgery. This literature review analyzes that the simulation techniques established thus far in hand surgery. METHODS A comprehensive literature search was performed on PubMed. Search results were filtered by title and abstract to isolate articles that were relevant to simulation in hand surgery. Articles that were nonspecific to the hand, non-English and cadaveric were excluded. Additional articles were identified through references from the initial search. RESULTS A total of 1192 articles were yielded from the initial query. After the application of the inclusion criteria, this was narrowed down to 28 articles. Another 8 additional articles were excluded as they did not pertain to the hand although the simulators could be adapted for hand surgery. A total of 20 articles were included in this study. CONCLUSIONS Surgical simulation is a growing and essential field of surgical education. Simulators in hand surgery are limited and require further research and validation. Like other surgical subspecialties, hand surgery may benefit from the adoption of an official simulation curriculum for the assessment of residents and enhancement of technical skills.
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Affiliation(s)
- Humza Y Saleem
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jamie L Kaplan
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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7
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Lin JA, Pierce L, Murray SG, Soleimani H, Wick EC, Sosa JA, Hirose K. Estimation of Surgical Resident Duty Hours and Workload in Real Time Using Electronic Health Record Data. JOURNAL OF SURGICAL EDUCATION 2021; 78:e232-e238. [PMID: 34507910 PMCID: PMC9335013 DOI: 10.1016/j.jsurg.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the use of electronic health record (EHR) data to estimate surgery resident duty hours and monitor real time workload. DESIGN Retrospective analysis of resident duty hours logged using a voluntary global positioning system (GPS)-based smartphone application compared to duty hour estimates by an EHR-based algorithm. The algorithm estimated duty hours using EHR activity data and operating room logs. A dashboard was developed through Plan-Do-Study-Act cycles for real-time monitoring of workload. SETTING Single tertiary/quaternary medical center general surgery residency program with approximately 90 categorical, preliminary, and integrated residents at eight clinical sites. PARTICIPANTS Categorical, preliminary, and integrated surgery residents of all clinical years who volunteered to pilot a GPS application to track duty hours. RESULTS Of 2,623 work periods by 59 residents were logged with both methods. EHR-estimated work periods started later than GPS logs (median 0.3 hours, interquartile range [IQR] -0.1 - 0.3); EHR-estimated work periods ended earlier than GPS logs (median 0.1 hours, IQR -0.7 - 0.3); and EHR-estimated duty hour totals were less than totals logged by GPS (median -0.3 hours, IQR -0.8 - +0.1). Overall correlation between weekly duty hours logged by EHR and GPS was 0.79. Correlations between the 2 systems stratified from PGY-1 through PGY-5 were 0.76, 0.64, 0.82, 0.87, and 0.83, respectively. The algorithm identified six 80-hour workweek violations (averaged over 4 weeks), while GPS logs identified 8. EHR-based duty hours and operational data were integrated into a dashboard to enable real time monitoring of resident workloads. CONCLUSIONS EHR-based estimation of surgical resident duty hours has good correlation with GPS-based assessment of duty hours and identifies most workweek duty hour violations. This approach allows for dynamic workload monitoring and may be combined with operational data to anticipate and prevent duty hour violations, thereby optimizing learning.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Logan Pierce
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sara G Murray
- Department of Medicine, University of California San Francisco, San Francisco, California; Health Informatics, University of California San Francisco, San Francisco, California
| | - Hossein Soleimani
- Health Informatics, University of California San Francisco, San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
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Abstract
Sufficient sleep is vital to the health and safety of healthcare workers and patients alike. Despite this, formal sleep promotion programs rarely exist within healthcare. Guidance does exist for how to incorporate strategies within healthcare organizations. Nurse leaders can spearhead efforts by promoting healthy sleep and instituting change through scheduling practices, unit policies, and supporting staff when barriers to healthy sleep develop.
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Affiliation(s)
- Beverly M Hittle
- Author Affiliations: Assistant Professor (Dr Hittle), College of Nursing, University of Cincinnati; Associate Professor (Dr Daraiseh), University of Cincinnati, Department of Pediatrics, Cincinnati Children's Hospital, Ohio
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Day P, Lawson J, Mantri S, Jain A, Rabago D, Lennon R. Physician moral injury in the context of moral, ethical and legal codes. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107225. [PMID: 34290114 DOI: 10.1136/medethics-2021-107225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to 'burnout', there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how-if at all-this changes anything.The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.
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Affiliation(s)
- Philip Day
- Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer Lawson
- Department of Pediatrics and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University of School Medicine, Durham, North Carolina, USA
| | - Sneha Mantri
- Department of Neurology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abhi Jain
- St Mark's School of Texas, Dallas, Texas, USA
| | - David Rabago
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robert Lennon
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Devine JK, Schwartz LP, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons S. Trends in Strategic Napping in Surgical Residents by Gender, Postgraduate Year, Work Schedule, and Clinical Rotation. JOURNAL OF SURGICAL EDUCATION 2021; 78:1256-1268. [PMID: 33229212 DOI: 10.1016/j.jsurg.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify surgical resident and clinical rotation attributes which predict on-shift napping through objectively measured sleep patterns and work schedules over a 2-month period. DESIGN In a cross-sectional study, participants provided schedules, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu watch) continuously for 8 weeks. Multiple linear regression predicted percent days with on-shift napping from resident and rotation characteristics. SETTING Greater Washington, DC area hospitals. PARTICIPANTS Twenty-two (n = 22) surgical residents rotating in at least 1 of 5 different clinical rotation categories. RESULTS Residents slept 6 hours within a 24-hour period (370 ± 129 minutes) with normal sleep efficiency (sleep efficiency (SE): 87.13% ± 7.55%). Resident ESS scores indicated excessive daytime sleepiness (11.64 ± 4.03). Ninety-five percent (n = 21) of residents napped on-shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 23:00 and 05:00 hours. Earlier shift start times predicted less on-shift napping (B = -0.08, SE = 0.04, β = -2.40, t = -2.09, p = 0.05) while working more night shifts (B = 1.55, SE = 0.44, β = 4.12, t = 3.52, p = 0.003) and shifts over 24 hours (B = 1.45, SE = 0.55, β = 1.96, t = 2.63, p = 0.01) predicted more frequent on-shift napping. CONCLUSIONS Residents are taking advantage of opportunities to nap on-shift. Working at night seems to drive on-shift napping. However, residents still exhibit insufficient sleep and daytime sleepiness which could reduce competency and represent a safety risk to themselves and/or patients. These findings will help inform intervention strategies which are tailored to surgical residents using a biomathematical model of fatigue.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltmore Maryland
| | | | | | - Lisa Boyle
- Medstar Georgetown University Hospital, Washington, DC
| | - Jonathan E Davis
- Georgetown University School of Medicine, Washington, DC; MedStar Health Research Institute, Hyattsville, Maryland
| | - Mark Smith
- MedStar Institutes for Innovation, Washington, DC
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Barnard M, Mellinger JD, Barnard M, Mellinger JD. Figuring in fatigue: A commentary on Schwartz et al., “Fatigue in surgical residents: An analysis of duty-hours and the effect of hypothetical naps on predicted performance”. Am J Surg 2021; 221:864-865. [DOI: 10.1016/j.amjsurg.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
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Meo N, Kim CS, Ilgen JS, Choe JH, Singh N, Joyner B. Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington. J Grad Med Educ 2020; 12:678-681. [PMID: 33391590 PMCID: PMC7771595 DOI: 10.4300/jgme-d-20-00430.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nicholas Meo
- Assistant Professor, Department of Medicine, University of Washington
| | - Christopher S Kim
- Associate Professor, Department of Medicine, University of Washington School of Medicine
| | - Jonathan S Ilgen
- Associate Professor, Department of Emergency Medicine, and Associate Chair for Faculty Development and Education, University of Washington School of Medicine
| | - John H Choe
- Associate Professor, Department of Medicine, and Associate Program Director, Internal Medicine Residency Program, University of Washington School of Medicine
| | - Niten Singh
- Professor, Department of Surgery, and Program Director, Vascular Surgery Integrated Residency And Fellowship Program, University of Washington School of Medicine
| | - Byron Joyner
- Professor, Department of Urology, and Designated Institutional Officer, University of Washington School of Medicine
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Bergmeister KD, Aman M, Kramer A, Schenck TL, Riedl O, Daeschler SC, Aszmann OC, Bergmeister H, Golriz M, Mehrabi A, Hundeshagen G, Enkhbaatar P, Kinsky MP, Podesser BK. Simulating Surgical Skills in Animals: Systematic Review, Costs & Acceptance Analyses. Front Vet Sci 2020; 7:570852. [PMID: 33195561 PMCID: PMC7554573 DOI: 10.3389/fvets.2020.570852] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Modern surgery demands high-quality and reproducibility. Due to new working directives, resident duty hours have been restricted and evidence exists that pure on-the-job training provides insufficient exposure. We hypothesize that supplemental simulations in animal models provide a realistic training to augment clinical experiences. This study reviews surgical training models, their costs and survey results illustrating academic acceptance. Methods: Animal models were identified by literature research. Costs were analyzed from multiple German and Austrian training programs. A survey on their acceptance was conducted among faculty and medical students. Results: 915 articles were analyzed, thereof 91 studies described in-vivo animal training models, predominantly for laparoscopy (30%) and microsurgery (24%). Cost-analysis revealed single-training costs between 307€ and 5,861€ depending on model and discipline. Survey results illustrated that 69% of the participants had no experience, but 66% would attend training under experienced supervision. Perceived public acceptance was rated intermediate by medical staff and students (4.26; 1–low, 10 high). Conclusion: Training in animals is well-established and was rated worth attending in a majority of a representative cohort to acquire key surgical skills, in light of reduced clinical exposure. Animal models may therefore supplement the training of tomorrow's surgeons to overcome limited hands-on experience until virtual simulations can provide such educational tools.
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Affiliation(s)
- Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner University of Health Sciences, Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Pölten, Krems, Austria
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Anne Kramer
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner University of Health Sciences, Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Pölten, Krems, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Thilo L Schenck
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Otto Riedl
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Simeon C Daeschler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Hospital Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Helga Bergmeister
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Hospital Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Michael P Kinsky
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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Philibert I, Blouin D. Responsiveness to societal needs in postgraduate medical education: the role of accreditation. BMC MEDICAL EDUCATION 2020; 20:309. [PMID: 32981520 PMCID: PMC7520978 DOI: 10.1186/s12909-020-02125-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Social accountability in medical education has been defined as an obligation to direct education, research, and service activities toward the most important health concerns of communities, regions, and nations. Drawing from the results of a summit of international experts on postgraduate medical education and accreditation, we highlight the importance of local contexts in meeting societal aims and present different approaches to ensuring societal input into medical education systems around the globe. MAIN TEXT We describe four priorities for social responsiveness that postgraduate medical education needs to address in local and regional contexts: (1) optimizing the size, specialty mix, and geographic distribution of the physician workforce; (2) ensuring graduates' competence in meeting societal goals for health care, population health, and sustainability; (3) promoting a diverse physician workforce and equitable access to graduate medical education; and (4) ensuring a safe and supportive learning environment that promotes the professional development of physicians along with safe and effective patient care in settings where trainees participate in care. We relate these priorities to the values proposed by the World Health Organization for social accountability: relevance, quality, cost-effectiveness, and equity; discuss accreditation as a lever for change; and describe existing and evolving efforts to make postgraduate medical education socially responsive. CONCLUSION Achieving social responsiveness in a competency-based postgraduate medical education system requires accrediting organizations to ensure that learning emphasizes relevant competencies in postgraduate curricula and educational experiences, and that graduates possess desired attributes. At the same time, institutions sponsoring graduate medical education need to provide safe and effective patient care, along with a supportive learning and working environment.
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Affiliation(s)
- Ingrid Philibert
- Department of Medical Education, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT USA
| | - Danielle Blouin
- Faculty of Health Sciences (Department of Emergency Medicine) and Faculty of Education, Queen’s University, Kingston, Ontario Canada
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Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators - An Observational Study. Acad Radiol 2020; 27:1025-1032. [PMID: 31481346 DOI: 10.1016/j.acra.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. MATERIALS AND METHODS In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). RESULTS The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without. CONCLUSION The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.
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Somerson JS, Patton A, Ahmed AA, Ramey S, Holliday EB. Burnout Among United States Orthopaedic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:961-968. [PMID: 32171748 DOI: 10.1016/j.jsurg.2020.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/06/2019] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE There is growing interest in the problem of burnout among physicians. Here, we examine the factors associated with burnout in orthopedic surgical training. DESIGN An Internet-based anonymous survey assessing workload, work-life balance, education, and resident-specific factors such as marital status and postgraduate year was developed. The survey was distributed to United States orthopedic surgery residency directors in September 2018, and program directors were asked to forward the survey to their trainees. Multivariable analysis assessed correlations with burnout. SETTING All 161 Accreditation Council for Graduate Medical Education (ACGME)-accredited United States orthopedic surgery residency programs. PARTICIPANTS Two hundred and three United States orthopedic surgery residents. RESULTS Thirty-eight percent of respondents reported symptoms of burnout. Even so, the vast majority did not regret choosing a medical career (95%) or their choice of residency program (90%). Greater than half of trainees who responded reported educational debt over $200,000. Thirteen percent reported receiving verbal abuse from faculty more than rarely. On multivariable analysis, 3 factors emerged that were associated with higher burnout: working more than 80 hours per week (odds ratio [OR] 2.8; range, 1.1-7.8), use of electronic medical record more than 20 hours per week (OR 2.1; range 1.0-4.5), and receiving verbal abuse from faculty more than rarely (OR 3.7; range, 1.3-11.5). The perception of adequate nursing support was associated with lower burnout (OR 0.2; range, 0.04-0.5). CONCLUSIONS More than one-third of orthopedic trainees are experiencing burnout, but most still maintain high levels of career satisfaction. The key factors strongly associated with resident burnout are modifiable. Targeted interventions related to these factors should be evaluated for their potential to reduce burnout in orthopedic surgery residents. CLINICAL RELEVANCE Strategies to reduce the development of burnout have the potential to improve quality of care and decrease medical errors.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas.
| | - Andrew Patton
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Awad A Ahmed
- University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida
| | | | - Emma B Holliday
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Gupta A, Watkins AC, Fahey TJ, Barie PS, Narayan M. Entrustable Professional Activities: Do General Surgery Residents Trust Them? JOURNAL OF SURGICAL EDUCATION 2020; 77:520-526. [PMID: 31948866 DOI: 10.1016/j.jsurg.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/29/2019] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The American Board of Surgery has initiated a pilot study to investigate the incorporation of Entrustable Professional Activities (EPAs) into the training of general surgery residents (GSR). Limited data exist on perception of EPAs by GSR. We aimed to assess the impact of EPAs on GSR for 2 included program topics: inguinal hernia and general surgery consultation. STUDY DESIGN A 21-question, cross-sectional, Likert scale survey was distributed to 64 GSR at an urban university hospital to assess perceptions and apprehensions regarding EPA implementation. The Mann-Whitney U test was used to analyze differences in responses between junior residents (PGY 1-3) and senior residents (PGY 4-5), and by gender of respondent, α = 0.05. RESULTS Forty-one (64%) GSR completed surveys. Approximately one-half of respondents had "faint to some" knowledge about EPAs. Fifty-seven percent of GSR were "moderately to highly concerned" about being assessed by attending surgeons with whom they did not have a prior relationship. Additionally, concerns were raised about being assessed by attending surgeons who may have observed their patient interaction only in part. Most GSR expressed "little to no concern" about impact of EPAs to potentially increase workload, the view of their program director as to their clinical competency, or American Board of Surgery plans to use collected data. Forty-two percent GSR in PGY 1 to 3 were "moderately to highly" concerned about impact on progression to the next year of residency, whereas senior GSR had "little to no concern." Most GSR (57%) expressed "moderate to high" concern about emergency medicine attending physicians evaluating them. Similar themes regarding EMA evaluation were identified in the comments section of the survey. CONCLUSIONS EPAs are intended to be a major part of GSR's competency-based assessment and advancement. More work needs to be done to alleviate concerns as to who should provide assessments, as well as in defining how EPAs will be used to assess clinical competency.
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Affiliation(s)
- Aakanksha Gupta
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Anthony C Watkins
- Division of Transplantation, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Thomas J Fahey
- Section of Endocrine Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York; Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mayur Narayan
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York.
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Demirtaş A, Karadeniz H, Akman YE, Duymuş TM, Çarkcı E, Azboy İ. Academic productivity and obstacles encountered during residency training: A survey among residents in orthopedics and traumatology programs in Turkey. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:311-319. [PMID: 32442120 DOI: 10.5152/j.aott.2020.03.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the academic productivity of and the obstacles encountered by orthopedic residents in Turkey. METHODS Overall, 220 orthopedic specialists who were registered in the Ministry of Health and had started orthopedic residency between 2009 and 2010 were invited to participate in a survey through e-mail. The survey comprised a total of 19 questions to evaluate the academic works conducted and obstacles encountered during residency. Academic work was defined as an article published in the peer-reviewed journals as well as an oral or poster presentation at a national or international congress. Case reports, letters to the editor, and technical notes were excluded. RESULTS Data were obtained from 116 respondents who completed the survey. In peer-reviewed journals in Science Citation Index (SCI) or SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.09 and 0.73, respectively. In peer-reviewed journals other than those in SCI and SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.37 and 1, respectively. The mean number of oral and poster presentations per resident at national and international congresses was 2.63 and 4.67, respectively. No significant difference in the number of academic works was noted between the regions and institutions (p>0.05). A significant positive correlation was observed between the number of associate professors and assistant professors in the clinic and the total number of academic works (article plus presentation) (p<0.01 and p=0.017, respectively). Regarding encouragement and support to academic works, 6.9% of the respondents found the clinic to be excellent, 20.7% good, 24.1% moderate, and 48.3% bad. No significant difference in encouragement and support to academic works was noted among the institutions (p=0.115). The most common obstacle encountered in conducting academic works was long working hours (74.5%). CONCLUSION Regardless of the region and institution, the participation of orthopedic residents in academic works is low in Turkey. Several obstacles were encountered in conducting academic works, with the most common being long working hours. LEVEL OF EVIDENCE Level IV, Diagnostic study.
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Affiliation(s)
- Abdullah Demirtaş
- Department of Orthopaedics and Traumatology, Medeniyet University, School of Medicine, İstanbul, Turkey
| | - Hilmi Karadeniz
- Department of Orthopaedics and Traumatology, Bahçelievler Medical Park Hospital, İstanbul, Turkey
| | - Yunus Emre Akman
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Tahir Mutlu Duymuş
- Clinic of Orthopedics and Traumatology, Özel Saygı Hospital, İstanbul, Turkey
| | - Engin Çarkcı
- Department of Orthopaedics and Traumatology, Bahçelievler Medical Park Hospital, İstanbul, Turkey
| | - İbrahim Azboy
- Department of Orthopaedics and Traumatology, Medipol University, School of Medicine, İstanbul, Turkey
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Moura FS, Ita de Miranda Moura E, Pires de Novais MA. Physicians' working time restriction and its impact on patient safety: an integrative review. Rev Bras Med Trab 2020; 16:482-491. [PMID: 32754663 PMCID: PMC7394539 DOI: 10.5327/z1679443520180294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/22/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although shift work is a part of the physicians' routine, there is controversy on the length of shifts and adequate rest for safe professional practice. If on the one hand long working hours might have negative impact on patient safety by interfering with the psychological and physical functioning of physicians, on the other shorter working hours might impair the safety of patients due to interference with the continuity of care. OBJECTIVE To analyze the impact of restrictions to physicians' working hours on patient safety. METHOD Integrative literature review in which we surveyed studies on restriction to physicians' working time and patient safety included in databases National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) until May 2018. Thirty-five studies which met the inclusion criteria were included. RESULTS Patient safety outcomes analyzed in the included studies were mortality, adverse events, continuity of care, in-hospital complications, readmission rate and length of stay at hospital. Restriction to working time was associated with variable impact on patient safety indicators, but often did not modify their performance. CONCLUSION Restrictions to physicians' working time did not always improved patient safety indicators. Focusing on interventions which only seek to limit the workload of physicians might be insufficient to bring consistent improvement to patient care.
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Affiliation(s)
- Felipe Scipião Moura
- Department of Medicine, Universidade Federal de São Paulo – São Paulo (SP), Brazil
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Lambert T, Blessberger H, Fellner A, Steinwender C, Tekian A. Self-assessment of medical students and young physicians in training : Self-confidence of clinical competencies and working or learning environment. Wien Klin Wochenschr 2020; 132:155-160. [PMID: 32130522 DOI: 10.1007/s00508-020-01623-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In 2015 medical training regulations have been restructured for postgraduate medical training in Austria resulting in a significant shortening of the training period. Furthermore, a restriction of working hours for physicians to 48 h per week was implemented affecting the framework of postgraduate medical training. The aim of this study was to obtain a self-assessment of students and young physicians in Austria regarding their self-confidence in clinical skills and their working and learning environment. METHODS In this study 6th year medical students, physicians in their basic training (common trunk), physicians in family medicine training, and residents in their first 18 months of training were asked to participate in a survey. Self-reported data were collected for five different prespecified domains (communication, motor skills, knowledge, documentation, and emergency). RESULTS In all domains, self-confidence increased significantly during medical training. Analysis further revealed better results of residents compared with all other groups in all domains, whereas physicians in family medicine training only rated themselves better in the documentation domain (p = 0.010); however, the interest in family medicine was low, even among physicians in family medicine training. The workload significantly increased during medical education, with the highest stress levels for physicians in family medicine training and residents (p = 0.001). CONCLUSIONS Self-confidence of young physicians but also their stress levels increased during the medical training. Further studies are needed to answer the question why the interest in family medicine was so unexpectedly low in this cohort.
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Affiliation(s)
- Thomas Lambert
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria.
| | - Hermann Blessberger
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Alexander Fellner
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Clemens Steinwender
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago, Chicago, USA
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Impact of Caffeine Ingestion on the Driving Performance of Anesthesiology Residents After 6 Consecutive Overnight Work Shifts. Anesth Analg 2020; 130:66-75. [DOI: 10.1213/ane.0000000000004252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Work shift duration for emergency physicians – the shorter, the better: the French Experience. Eur J Emerg Med 2019; 26:396-397. [DOI: 10.1097/mej.0000000000000639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Residency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to determine the influence of night float on resident sleep patterns and quality of sleep. We hypothesized that total sleep time decreases during night float, increases as residents acclimate to night shift work, and returns to baseline during recovery.
Methods
This was a single-center observational study of 30 anesthesia residents scheduled to complete six consecutive night float shifts. Electroencephalography sleep patterns were recorded during baseline (three nights), night float (six nights), and recovery (three nights) using the ZMachine Insight monitor (General Sleep Corporation, USA). Total sleep time; light, deep, and rapid eye movement sleep; sleep efficiency; latency to persistent sleep; and wake after sleep onset were observed.
Results
Mean total sleep time ± SD was 5.9 ± 1.9 h (3.0 ± 1.2.1 h light; 1.4 ± 0.6 h deep; 1.6 ± 0.7 h rapid eye movement) at baseline. During night float, mean total sleep time was 4.5 ± 1.8 h (1.4-h decrease, 95% CI: 0.9 to 1.9, Cohen’s d = –1.1, P < 0.001) with decreases in light (2.2 ± 1.1 h, 0.7-h decrease, 95% CI: 0.4 to 1.1, d = –1.0, P < 0.001), deep (1.1 ± 0.7 h, 0.3-h decrease, 95% CI: 0.1 to 0.4, d = –0.5, P = 0.005), and rapid eye movement sleep (1.2 ± 0.6 h, 0.4-h decrease, 95% CI: 0.3 to 0.6, d = –0.9, P < 0.001). Mean total sleep time during recovery was 5.4 ± 2.2 h, which did not differ significantly from baseline; however, deep (1.0 ± 0.6 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.6, P = 0.001 *, P = 0.001) and rapid eye movement sleep (1.2 ± 0.8 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.9, P < 0.001 P < 0.001) were significantly decreased.
Conclusions
Electroencephalography monitoring demonstrates that sleep quantity is decreased during six consecutive night float shifts. A 3-day period of recovery is insufficient for restorative sleep (rapid eye movement and deep sleep) levels to return to baseline.
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Abstract
BACKGROUND There is worldwide interest in assessing the impact of accreditation systems to quantify their benefits to medical education and, through this, health care at the local and global levels. OBJECTIVE We analyzed ACGME-I Resident Survey data from Singapore for 2011-2018 to assess the impact of accreditation on residents' evaluations of their programs. METHODS We focused on 7 questions from the annual Resident Survey, which would be affected by accreditation compliance, along with a single global rating of respondents' overall perception of their program. We assessed for differences among specialty groupings (medical, surgical, and hospital-based) and Singapore's 3 health care systems. Repeated measures analysis of variance procedures was used to assess trends across time for the combined 8 items and each individual item. RESULTS Analysis of the combined items showed significant improvement over the 7 years Singaporean programs had accreditation. There were no effects for specialty type or sponsoring institution. Analyses of individual questions showed 6 of 8 were significant for improvement. For the individual question related to duty hour compliance, there was a significant interaction between time and specialty, suggesting medical specialties showed greater improvement across time compared to surgical and hospital-based specialties. CONCLUSIONS Implementation of accreditation in Singapore provided educational and clinical learning environment infrastructure not present prior to 2010, with the benefits of this reflected in residents' perceptions of their learning environment. Future assessments of the effects of accreditation might add stakeholder interviews to more fully describe its value and impact.
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Al-Kofahi M, Mohyuddin GR, Taylor ME, Eck LM. Reducing Resident Physician Workload to Improve Well Being. Cureus 2019; 11:e5039. [PMID: 31501731 PMCID: PMC6721886 DOI: 10.7759/cureus.5039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Resident physician’s well-being has been postulated to worsen with longer shifts. At our institution, the admitting physician evening shift (known as short call) had been associated with higher levels of stress and reduced well-being among residents due to longer work hours and an excessive number of admissions. We introduced an intermediate swing shift to help mitigate those effects. This study sought to assess the outcomes of introducing the swing shift on the timeliness of leaving the hospital for the short call physician, and the median number of admissions done by the short call, swing shift, and night shift resident physicians. Method The swing shift was designed to cover admitting duties from 4:00 to 11:00 pm on weekdays, with support from both the short call and night shift resident physicians. Internal Medicine residents in their second or third year of training and combined Medicine/Psychiatry residents in their third, fourth or fifth year of training, were surveyed prior to the implementation of the swing shift and four-months post-implementation. Time of leaving the hospital and number of admissions before and after the introduction of the swing shift were compared. Data were recorded as frequencies and presented as medians. Results There were 27 surveys completed prior to swing shift implementation and 43 surveys completed post-implementation with a response rate of 52% and 83%, respectively. Surveys post-implementation were divided into 29 for the short call shift survey, six for the swing shift survey, and eight for the night shift survey. Residents who did not perform the short call physician duties were excluded, limiting the prior to implementation surveys from 27 to 25 and the post-implementation short call surveys from 29 to 19. Prior to swing shift implementation, the median time of leaving for the short call physician was 8:30 to 9:00 pm; the median number of admissions were four and eight, done by short call physician and night shift physician, respectively. Whereas post-swing shift implementation, the median time of leaving for short call physician was 7:00 to 7:30 pm, and for swing shift physician was 11:30 pm to midnight. The median number of admissions were two, five, and five done by the short call, swing shift, and night shift physicians, respectively. All residents reported the swing shift allowed them to take better care of patients and follow up on their tasks. Discussion and conclusion Delayed resident physicians departure at the end of their respective shift was associated with extended shifts. It is thought to be caused by an increased number of admissions, late shift admissions, and time of day shift with 4:00 to 9:00 pm being the busiest. The addition of the swing shift increased the ability of the short call resident physician to leave the hospital at the end of their shift and reduced the median number of admissions done by the short call and night shift resident physicians, hence likely improving resident’s well-being while preserving the total number of admissions.
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Affiliation(s)
- Mejalli Al-Kofahi
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | | | - Melissa E Taylor
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | - Leigh M Eck
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
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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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Chan MK, Snell L, Philibert I. The education avenue of the clinical learning environment: A pragmatic approach. MEDICAL TEACHER 2019; 41:391-397. [PMID: 31008675 DOI: 10.1080/0142159x.2019.1566602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim: This perspective is part of a series of articles that are outcomes of a consensus conference, that seek to offer a comprehensive examination of the clinical learning environment (CLE), using different academic disciplines and areas of focus termed "avenues." The education dimensions of the CLE are discussed in detail in this perspective, along with critical linkages to the other avenues. Methods: Using iterative presentations, discussion and small group work, in October 2018, the consensus conference participants explored the education, psychological, sociocultural, diversity and inclusion, digital and architectural aspects of the CLE. Results: The education avenue of the CLE includes elements of teaching and learning such as the curriculum, clinical experiences, the assessment system, educational program governance, trainee selection, faculty development, and program evaluation and improvement. Within the educational domain, we focus on organizational and personal/social aspects of the CLE, including (1) curriculum design and deployment, including placement of trainees in clinical settings, organizational culture, practices and policies, and accreditation and regulatory requirements from the organizational domain (2) the education system, including assessment, program evaluation and organization and governance; and (3) elements from the personal and social domains, including peer-to-peer, trainee-faculty, and trainee-patient relationships that influence how and what postgraduate trainees learn, trainee selection, informal and hidden curricula, and trainees' perceptions of their learning environment. Conclusions: We provide suggestions for further research and recommendations for addressing challenges and facilitating improvement in the educational aspects of the CLE, along with actionable practice points.
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Affiliation(s)
- Ming-Ka Chan
- a Department of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba , Canada
| | - Linda Snell
- b Department of Medicine and Centre for Medical Education , McGill University , Montreal , Quebec , Canada
- c Royal College of Physicians and Surgeons of Canada , Ottawa, Ontario , Canada
| | - Ingrid Philibert
- d Formerly Accreditation Council of Graduate Medical Education , Chicago , IL , USA
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West JL, Fargen KM, Aschenbrenner CA, Wilson JA, Branch CL, Wolfe SQ, Hsu W. Commentary: Resident Operative Experience: Training an Expert Neurosurgeon. Neurosurgery 2019; 84:E279-E286. [DOI: 10.1093/neuros/nyz015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- James L West
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Carol A Aschenbrenner
- Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John A Wilson
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Charles L Branch
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Wesley Hsu
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Jagsi R, Padayachy L, Surender R. Preventing the tower from toppling for women in surgery. Lancet 2019; 393:495-497. [PMID: 30739668 DOI: 10.1016/s0140-6736(19)30246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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Baumgarten HD, Brown EG, Russell KW, Adzick NS, Laje P. Laparoscopic appendectomy - Outcomes of senior trainees operating without supervision versus experienced pediatric surgeons. J Pediatr Surg 2019; 54:276-279. [PMID: 30502007 DOI: 10.1016/j.jpedsurg.2018.10.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 11/15/2022]
Abstract
AIM OF THE STUDY Pediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent operative decision-making skills. We reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to experienced pediatric surgeons. METHODS We reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 pediatric surgery trainees during their last year of training (first 50 cases of each trainee). We compared the outcomes of those 500 cases to the outcomes of 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 cases of each surgeon). Data are expressed as mean (SD), unless otherwise indicated. A P value of ≤0.05 was regarded as significant. MAIN RESULTS Median age in the "trainees" and "surgeons" groups was 11 (range 2-22) and 12 (2-20) years, respectively (P = 0.35). The proportion of perforated appendicitis was similar: 98/500 (19.6%) in the trainees group and 42/200 (21%) in the surgeons group, respectively (P = 0.75). Mean operative time was 41 (SD 14.5) min in the trainees group vs. 39 (SD 16.1) min in the surgeons group (P = 0.05). Minor intraoperative complications occurred in 3/500 (0.6%) cases in the trainees group vs. 1/200 (0.5%) in the surgeons group (P = 0.69). No major complications occurred in either group. Mean hospital stay was 2 (range 0.5-26) and 2.3 (range 0.5-18) days in the trainees and surgeons groups, respectively (P = 0.25). There were 13/500 vs. 5/200 readmissions (P = 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (P = 0.91). CONCLUSION Allowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision to stimulate surgical autonomy is safe and does not compromise patient outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Heron D Baumgarten
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin G Brown
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathryn W Russell
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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31
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Jung SM. Current status and directions of resident education. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soo-Min Jung
- Department of Surgery, Samsung Medical Center, Seoul, Korea
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32
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Williams E, Martin SL, Fabrikant A. Factors associated with depressive symptoms in pharmacy residents. Am J Health Syst Pharm 2018; 75:1973-1981. [DOI: 10.2146/ajhp180211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Evan Williams
- College of Pharmacy, Roseman University of Health Sciences, Henderson, NV
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Pololi LH, Evans AT, Civian JT, Shea S, Brennan RT. Resident Vitality in 34 Programs at 14 Academic Health Systems: Insights for Educating Physicians and Surgeons for the Future. JOURNAL OF SURGICAL EDUCATION 2018; 75:1441-1451. [PMID: 29929814 DOI: 10.1016/j.jsurg.2018.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To clarify our understanding of how the culture of residency training influences the well-being of residents, this study reports on the vitality of residents at 34 programs across the United States and identifies characteristics of the programs, institutions and residents that are associated with high resident vitality. DESIGN In 2014 to 2015, residents nationally were surveyed using the validated C - Change Resident Survey. The survey assessed residents' vitality and 12 other dimensions that characterize residents' perspectives of the culture of the residency training programs: Self-efficacy, Institutional/program support, Relationships/inclusion/trust, Values alignment, Ethical/moral distress, Respect, Leadership aspirations, Mentoring, Work-life integration, Gender equity, Racial/ethnic minority equity, and self-assessed Competencies. Multilevel models were used to assess vitality within and across programs, and examine predictors including resident, program, and institution characteristics. PARTICIPANTS Two thousand four hundred and fifty-two residents from 11 General Surgery, 12 Internal Medicine, and 11 Pediatrics programs at 14 U.S. academic health systems. RESULTS One thousand seven hundred and eight residents responded (70% response rate). The mean Vitality score was 3.6 (range 1-5, where values of 4-5 represent high Vitality). There was wide variation among the 34 programs in the percent of residents who had high Vitality scores, ranging from 17% to 71%. However, the average Vitality scores within specialty (Surgery, Medicine, and Pediatrics) were not significantly different. The strongest predictors of Vitality were Work-life integration, Relationships/inclusion/trust, Institutional/program support, Res?>pect, Values alignment, and Ethical/moral distress, which together accounted for 50% of vitality variance. Individual demographics accounted for just 3% of variance. CONCLUSIONS Vitality is an essential component of resident well-being, and within each specialty there are programs that have excelled in promoting a culture of high vitality. Our findings suggest that we should test interventions to enhance resident vitality by focusing greater attention on providing institutional support, aligning individual and institutional values, integrating work and personal life, and facilitating relationships, inclusiveness and trust.
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Affiliation(s)
- Linda H Pololi
- Brandeis University, National Initiative on Gender, Culture and Leadership in Medicine: C - Change, Waltham, Massachusetts; Brandeis Women's Studies Research Center, Brandeis University, Waltham, Massachusetts.
| | - Arthur T Evans
- Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Janet T Civian
- Brandeis Women's Studies Research Center, Brandeis University, Waltham, Massachusetts
| | - Sandy Shea
- CIR Policy and Education Initiative, New York, New York
| | - Robert T Brennan
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Bilimoria KY, Chung JW, Hedges LV. External validity is also an ethical consideration in cluster-randomised trials of policy changes. BMJ Qual Saf 2018; 28:167. [PMID: 30314975 DOI: 10.1136/bmjqs-2018-008777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Karl Y Bilimoria
- Department of Surgery, Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois, USA
| | - Jeanette W Chung
- Department of Surgery, Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Chicago, Illinois, USA
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Jarrar M, Minai MS, Al-Bsheish M, Meri A, Jaber M. Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety. Int J Health Plann Manage 2018; 34:e387-e396. [PMID: 30221794 DOI: 10.1002/hpm.2656] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is no clear evidence that can guide decision makers regarding the appropriate shift length in the hospitals in Malaysia. Further, there is no study that explored the value of patient-centered care of nurses working longer shifts and its impact on the care outcomes. OBJECTIVE The study aims to investigate the effect of the hospital nurse shift length and patient-centered care on the perceived quality and safety of nurses in the medical-surgical and multidisciplinary wards in Malaysia. METHODS A cross-sectional survey has been conducted on 12 hospitals in Malaysia. Data have been collected via a questionnaire. A stratified sampling has been used. The Hayes macro regression analyses have been used to examine the mediating effects of patient-centered care between the effect of working long shifts on the perceived quality and patient safety. RESULTS There is a significant mediation effect of patient-centered care between the effect of shift length on the perceived quality (F = 42.90, P ˂ 0.001) and patient safety (F = 25.12, P ˂ 0.001). CONCLUSION Patient-centered care mitigates the effect of the shift length on the care outcomes. The study provides an input for the policymakers that patient-centered care and restructuring duty hours are important to provide high-quality patient care.
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Affiliation(s)
- Mu'taman Jarrar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Medical Education Department, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Mohd Sobri Minai
- College of Business, Universiti Utara Malaysia, Changlun, Kedah, Malaysia
| | - Mohammad Al-Bsheish
- Healthcare Administration Department, Batterjee Medical College (PMC), Jeddah, Saudi Arabia
| | - Ahmed Meri
- Center for Artificial Intelligence and Technology, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mustafa Jaber
- Faculty of Civil and Environmental Engineering, Universiti Tun Hussein Onn Malaysia, Parit Raja, Johor, Malaysia.,Nabu Research Academy, Baghdad, Iraq
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36
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Buser BR. A Perspective on the Sleep and Lifestyle Habits of Emergency Medicine Residents. J Osteopath Med 2018; 118:504-505. [DOI: 10.7556/jaoa.2018.117] [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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Liu BJ, Ordon M, Bodley J, Liu G, Kroft J. Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1586-1591. [PMID: 30025868 DOI: 10.1016/j.jogc.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether obstetrical patient outcomes have changed following the introduction of restricted resident work hours. METHODS A population-based retrospective cohort study of the effects of restricted duty hours for residents in July 2013 at three academic hospitals in Toronto, ON using linked health care databases. The study included 6763 deliveries in the 2 years pre-exposure and 5548 deliveries in the 2 years post-exposure. RESULTS The primary outcome, planned prior to data collection, was a composite index of 29 maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage, maternal infection, fetal mortality, NICU admissions, and surgical/obstetrical complications. There were seven secondary outcomes analysed: NICU admissions; neonatal death; maternal transfusion or postpartum hemorrhage; maternal infection; and three composite measures. A generalized estimating equation model, clustered by institution, was utilized to assess for differences post-intervention. We found no significant differences in baseline demographics between groups. After the implementation of duty hour restrictions, no significant difference was seen in the primary outcome. However, an increased incidence of composite maternal surgical/obstetrical outcomes (OR 1.191; 95% CI 1.037-1.367, P = 0.013) and transfusion/postpartum hemorrhage (OR 1.232; 95% CI 1.074-1.413, P = 0.003) was found. There were no significant differences in other secondary outcomes. CONCLUSION Since the implementation of resident duty hour restrictions, there was no overall change in patient outcomes. However, there was an increase in surgical/obstetrical complications and transfusion/postpartum hemorrhage. This suggests that duty hour restrictions may not be beneficial to patient outcomes. It highlights the need to further investigate the clinical impact of a change in resident duty hours.
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Affiliation(s)
- Brian J Liu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, Toronto, ON; The Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Janet Bodley
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Grace Liu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Jamie Kroft
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON.
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The poverty of theory: Evidence-based medicine and the social contract. J Trauma Acute Care Surg 2018; 85:7-11. [DOI: 10.1097/ta.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND New regulations for working hours of medical doctors have been implemented in Austria based on the European directive 2003/88/EG, limiting on-duty working hours to 48 h per week. Clinical work is, therefore, substantially reduced compared to previous decades, and little is known on physician and students' opinions on this matter. We illustrate survey results concerning on-job training, its difficulties, and implications for restricted working hours. METHODS We conducted an internal survey among M.D. and Ph.D. students and medical staff members at the Medical University of Vienna using the MedCampus system (CAMPUSOnline, Graz, Austria) and SPSS (V.21, IBM Corp, Armonk, NY, USA). RESULTS Participants were 36.5% staff members and 63.5% students. Students rated continuous education of physicians high at 9.19 ± 1.76 and staff members at 8.90 ± 2.48 on a 1-10 (1 unimportant, 10 most important) scale. Students rated limited time resources, while staff considered financial resources as the greatest challenge for in-hospital education. Overall, 28.85% thought that restricted working hours can positively influence education, while 19.04% thought the opposite and 52.11% were undecided. DISCUSSION Considering the limited available time and financial resources, education of tomorrow's medical doctors remains an important but difficult task. While participants of our survey rated education as very important despite its many challenges, the opinions towards limited working hours were not as clear. Given that over 50% are still undecided whether reduced work hours may also positively influence medical education, it clearly presents an opportunity to include the next generations of physicians in this undertaking.
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Affiliation(s)
- Konstantin D Bergmeister
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Martin Aman
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Day KM, Zoog ES, Kluemper CT, Scott JK, Steffen CM, Kennedy JW, Jemison DM, Rehm JP, Brzezienski MA. Progressive Surgical Autonomy Observed in a Hand Surgery Resident Clinic Model. JOURNAL OF SURGICAL EDUCATION 2018; 75:450-457. [PMID: 28967577 DOI: 10.1016/j.jsurg.2017.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/31/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Resident clinics (RCs) are intended to catalyze the achievement of educational milestones through progressively autonomous patient care. However, few studies quantify their effect on competency-based surgical education, and no previous publications focus on hand surgery RCs (HRCs). We demonstrate the achievement of progressive surgical autonomy in an HRC model. DESIGN A retrospective review of all patients seen in a weekly half-day HRC from October 2010 to October 2015 was conducted. Investigators compiled data on patient demographics, provider encounters, operational statistics, operative details, and dictated surgical autonomy on an ascending 5 point scoring system. SETTING A tertiary hand surgery referral center. RESULTS A total of 2295 HRC patients were evaluated during the study period in 5173 clinic visits. There was an average of 22.6 patients per clinic, including 9.0 new patients with 6.5 emergency room referrals. Totally, 825 operations were performed by 39 residents. Trainee autonomy averaged 2.1/5 (standard deviation [SD] = 1.2), 3.4/5 (SD = 1.3), 2.1/5 (SD = 1.3), 3.4/5 (SD = 1.2), 3.2/5 (SD = 1.5), 3.5/5 (SD = 1.5), 4.0/5 (SD = 1.2), 4.1/5 (SD = 1.2), in postgraduate years 1 to 8, respectively. Linear mixed model analysis demonstrated training level significantly effected operative autonomy (p = 0.0001). Continuity of care was maintained in 79.3% of cases, and patients were followed an average of 3.9 clinic encounters over 12.4 weeks. CONCLUSIONS Our HRC appears to enable surgical trainees to practice supervised autonomous surgical care and provide a forum in which to observe progressive operative competency achievement during hand surgery training. Future studies comparing HRC models to non-RC models will be required to further define quality-of-care delivery within RCs.
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Affiliation(s)
- Kristopher M Day
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee.
| | - Evon S Zoog
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of General Surgery, Hayes Hand Center, Chattanooga, Tennessee
| | - Chase T Kluemper
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee
| | - Jillian K Scott
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee
| | - Caleb M Steffen
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee
| | - James Woodfin Kennedy
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee
| | - David Marshall Jemison
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee
| | - Jason P Rehm
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee
| | - Mark A Brzezienski
- University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee
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Kasten SJ, Cederna PS. Commentary on: Demystifying the "July Effect" in Plastic Surgery: A Multi-Institutional Study. Aesthet Surg J 2018; 38:225-227. [PMID: 29040371 DOI: 10.1093/asj/sjx158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven J Kasten
- Section of Plastic Surgery, University Michigan School of Medicine, Ann Arbor, MI
| | - Paul S Cederna
- Section of Plastic Surgery, University Michigan School of Medicine, Ann Arbor, MI
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Nevel KS, Southerland AM, Kilgore SM, Gutmann L. Residency Training: The Review Committee for Neurology. Neurology 2017; 90:41-44. [DOI: 10.1212/wnl.0000000000004766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wolf SJ, Akhtar S, Gross E, Barnes D, Epter M, Fisher J, Moreira M, Smith M, House H. ACGME Clinical and Educational Work Hour Standards: Perspectives and Recommendations from Emergency Medicine Educators. West J Emerg Med 2017; 19:49-58. [PMID: 29383056 PMCID: PMC5785201 DOI: 10.5811/westjem.2017.11.35265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The American College of Emergency Physicians (ACEP) and the Council of Emergency Medicine Residency Directors (CORD) were invited to contribute to the 2016 Accreditation Council for Graduate Medical Education’s (ACGME) Second Resident Duty Hours in the Learning and Working Environment Congress. We describe the joint process used by ACEP and CORD to capture the opinions of emergency medicine (EM) educators on the ACGME clinical and educational work hour standards, formulate recommendations, and inform subsequent congressional testimony. Methods In 2016 our joint working group of experts in EM medical education conducted a consensus-based, mixed-methods process using survey data from medical education stakeholders in EM and expert iterative discussions to create organizational position statements and recommendations for revisions of work hour standards. A 19-item survey was administered to a convenience sample of 199 EM residency training programs using a national EM educational listserv. Results A total of 157 educational leaders responded to the survey; 92 of 157 could be linked to specific programs, yielding a targeted response rate of 46.2% (92/199) of programs. Respondents commented on the impact of clinical and educational work-hour standards on patient safety, programmatic and personnel costs, resident caseload, and educational experience. Using survey results, comments, and iterative discussions, organizational recommendations were crafted and submitted to the ACGME. Conclusion EM educators believe that ACGME clinical and educational work hour standards negatively impact the learning environment and are not optimal for promoting patient safety or the development of resident professional citizenship.
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Affiliation(s)
- Stephen J Wolf
- University of Virginia School of Medicine, Department of Emergency Medicine, Charlottesville, Virginia
| | - Saadia Akhtar
- Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.,Council of Emergency Medicine Residency Directors, Irving, Texas
| | - Eric Gross
- University of California Davis School of Medicine, Department of Emergency Medicine, Sacramento, California.,American College of Emergency Physicians, Irving, Texas
| | - David Barnes
- University of California Davis School of Medicine, Department of Emergency Medicine, Sacramento, California
| | - Michael Epter
- Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona.,Council of Emergency Medicine Residency Directors, Irving, Texas
| | - Jonathan Fisher
- University of Arizona College of Medicine- Phoenix, Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona
| | - Maria Moreira
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado.,Council of Emergency Medicine Residency Directors, Irving, Texas
| | - Michael Smith
- University of Queensland/Ochsner Health System, Department of Emergency Medicine, New Orleans, Louisiana
| | - Hans House
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa.,American College of Emergency Physicians, Irving, Texas
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Burchiel KJ, Zetterman RK, Ludmerer KM, Philibert I, Brigham TP, Malloy K, Arrighi JA, Ashley SW, Bienstock JL, Carek PJ, Correa R, Forstein DA, Gaiser RR, Gold JP, Keepers GA, Kennedy BC, Kirk LM, Kothari A, Langdale LA, Shayne PH, Stain SC, Woods SK, Wyatt-Johnson C, Nasca TJ. The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment. J Grad Med Educ 2017; 9:692-696. [PMID: 29270256 PMCID: PMC5734321 DOI: 10.4300/jgme-d-17-00317.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Porter SE, Razi AE, Ramsey TB. Novel Strategies to Improve Resident Selection by Improving Cultural Fit: AOA Critical Issues. J Bone Joint Surg Am 2017; 99:e120. [PMID: 29135675 DOI: 10.2106/jbjs.17.00225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Residency selection is a perennial multifactorial process that differs considerably from the recruitment processes that other professional occupations enjoy. The 2016 meeting of the American Orthopaedic Association's Council of Orthopaedic Residency Directors highlighted a series of symposia that sought to present a novel manner of resident selection. Specifically, the presenters for each symposium were asked to do the following: present some general recruitment best practices in industries outside of medicine, present how branding of a program may translate into a better interview season, investigate evidence that the applicant pool to orthopaedic surgery may have changed and that residency program brands may have to reflect this, and assess our current evaluation techniques for talent identification and resident selection with respect to a specific department's appearance or brand. The meeting concluded with an understanding of the level to which programs can successfully create or adopt a brand and how this may go a long way in focusing the entire match process and allow emphasis to be placed on applicants who possess desired traits. The goal for this meeting was that attendees would leave with tangible practices and techniques that could be adopted at their home institutions.
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Affiliation(s)
- Scott E Porter
- 1Department of Orthopaedic Surgery, Greenville Health System, Greenville, South Carolina 2Department of Orthopaedic Surgery, NYU Langone Health, New York, NY 3University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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Sandefur BJ, Shewmaker DM, Lohse CM, Rose SH, Colletti JE. Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center. BMC MEDICAL EDUCATION 2017; 17:199. [PMID: 29126406 PMCID: PMC5681814 DOI: 10.1186/s12909-017-1033-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) implemented revisions to resident duty hour requirements (DHRs) in 2011 to improve patient safety and resident well-being. Perceptions of DHRs have been reported to vary by training stage and specialty among internal medicine and general surgery residents. The authors explored perceptions of DHRs among all residents at a large academic medical center. METHODS The authors administered an anonymous cross-sectional survey about DHRs to residents enrolled in all ACGME-accredited core residency programs at their institution. Residents were categorized as medical and pediatric, surgery, or other. RESULTS In total, 736 residents representing 24 core specialty residency programs were surveyed. The authors received responses from 495 residents (67%). A majority reported satisfaction (78%) with DHRs and believed DHRs positively affect their training (73%). Residents in surgical specialties and in advanced stages of training were significantly less likely to view DHRs favorably. Most respondents believed fatigue contributes to errors (89%) and DHRs reduce both fatigue (80%) and performance of clinical duties while fatigued (74%). A minority of respondents (37%) believed that DHRs decrease medical errors. This finding may reflect beliefs that handovers contribute more to errors than fatigue (41%). Negative perceived effects included diminished patient familiarity and continuity of care (62%) and diminished clinical educational experiences for residents (41%). CONCLUSIONS A majority of residents reported satisfaction with the 2011 DHRs, although satisfaction was significantly less among residents in surgical specialties and those in advanced stages of training.
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Affiliation(s)
- Benjamin J. Sandefur
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Diana M. Shewmaker
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | - Steven H. Rose
- Department of Anesthesiology, Mayo Clinic, Rochester, MN USA
| | - James E. Colletti
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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Training Surgeons in the Current US Healthcare System: A Review of Recent Changes in Resident Education. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0195-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yadava OP. Wake up call. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Asch DA, Bilimoria KY, Desai SV. Resident Duty Hours and Medical Education Policy - Raising the Evidence Bar. N Engl J Med 2017; 376:1704-1706. [PMID: 28402246 DOI: 10.1056/nejmp1703690] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David A Asch
- From the University of Pennsylvania and the Philadelphia VA Medical Center - both in Philadelphia (D.A.A.); Northwestern University, Chicago (K.Y.B.); and Johns Hopkins University, Baltimore (S.V.D.)
| | - Karl Y Bilimoria
- From the University of Pennsylvania and the Philadelphia VA Medical Center - both in Philadelphia (D.A.A.); Northwestern University, Chicago (K.Y.B.); and Johns Hopkins University, Baltimore (S.V.D.)
| | - Sanjay V Desai
- From the University of Pennsylvania and the Philadelphia VA Medical Center - both in Philadelphia (D.A.A.); Northwestern University, Chicago (K.Y.B.); and Johns Hopkins University, Baltimore (S.V.D.)
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Progressive Surgical Autonomy in a Plastic Surgery Resident Clinic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1318. [PMID: 28607848 PMCID: PMC5459631 DOI: 10.1097/gox.0000000000001318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/07/2017] [Indexed: 12/23/2022]
Abstract
Background: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC. Methods: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program. Surgical autonomy was scored on a 5-point scale based on dictated operative reports. Graduated chief residents were additionally surveyed by anonymous online survey. Results: Thousand one hundred forty-four patients were seen in 3,390 clinic visits. Six hundred fifty-three operations were performed by 23 total residents, including 10 graduating chiefs. Senior resident autonomy averaged 3.5/5 (SD = 1.5), 3.6/5 (SD = 1.5), to 3.8/5 (SD = 1.3) in postgraduate years 6, 7, and 8, respectively. A linear mixed model analysis demonstrated that training level had a significant impact on operative autonomy when comparing postgraduate years 6 and 8 (P = 0.026). Graduated residents’ survey responses (N = 10; 100% response rate) regarded PSRC as valuable for surgical experience (4.1/5), operative autonomy (4.4/5), medical knowledge development (4.7/5), and the practice of Accreditation Council of Graduate Medical Education core competencies (4.3/5). Preoperative or postoperative continuity of care was maintained in 93.5% of cases. Conclusion: The achievement of progressive surgical autonomy may be demonstrated within a PSRC model.
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