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Lazaro TT, Katlowitz KA, Karas PJ, Srinivasan VM, Walls E, Collier G, Raza SM, Curry DJ, Ropper AE, Fuentes A, Gopinath SP, Rao G, Patel AJ. The impact of a night float system on operative experience in neurosurgery residency. J Neurosurg 2022; 138:1117-1123. [PMID: 36087325 DOI: 10.3171/2022.4.jns212612] [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: 11/12/2021] [Accepted: 04/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Since the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions in 2003, many residency programs have adopted a night float system to comply with time constraints. However, some surgical subspecialities have been concerned that use of a night float system deprives residents of operative experience. In this study, the authors describe their training program's transition to a night float system and its impact on resident operative experience. METHODS The authors conducted a single-program study of resident surgical case volume before and after implementing the night float system at 3 of their 5 hospitals from 2014 to 2020. The authors obtained surgical case numbers from the ACGME case log database. RESULTS Junior residents received a concentrated educational experience, whereas senior residents saw a significant decrease from 112 calls/year to 17. Logged cases significantly increased after implementation of the night float system (8846 vs 10,547, p = 0.04), whereas cases at non-night float hospitals remained the same. This increase was concurrent with an increase in hospital cases. This difference was mainly driven by senior resident cases (p = 0.010), as junior and chief residents did not show significant differences in logged cases (p > 0.40). Lead resident cases increased significantly after implementation of the night float system (6852 vs 8860, p = 0.04). When normalized for increased hospital cases, resident case increases were not statistically significant. CONCLUSIONS Transitioning to a night float call system at the authors' institution increased overall resident operative cases, particularly for lead resident surgeons. Based on the results of this study, the authors recommend the use of a night float call system to consolidate night calls, which increases junior resident-level educational opportunities and senior resident cases.
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Affiliation(s)
- Tyler T Lazaro
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Patrick J Karas
- 3Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Visish M Srinivasan
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Gina Collier
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Shaan M Raza
- 5University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel J Curry
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alfonso Fuentes
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Ganesh Rao
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,6Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas; and.,7Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Carr MM, Friedel J, O'Brien D, Foreman AM, Wirth O. Perceptions of Fatigue and Safety Climate Pertaining to Residency Duty-Hour Restrictions. Cureus 2022; 14:e28929. [PMID: 36237775 PMCID: PMC9547532 DOI: 10.7759/cureus.28929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The Accreditation Council for Graduate Medical Education (ACGME), which sets the standards for residency training, instituted work-hour restrictions in 2003. Our purpose was to assess residents’ perceptions of fatigue and local safety climate specific to these duty-hour restrictions. Methods: All residents (N=433) at one university were emailed a link to a survey in 2019. The survey included demographic details, on-call descriptors, an 18-point climate survey (CS), and the 33-point Chalder Fatigue Questionnaire (CFQ). The CS was adapted from a commonly used safety climate scale and intended to measure the respondent’s perceptions of their program’s attitudes and practices around resident duty-hour compliance. A Pearson correlational analysis was used to determine if there were associations between the variables. Results: Mean CS score was 12.89 (95% confidence interval, CI 12.32-13.46, N=164, 48.5%). Respondents were most likely to disagree with “Residents are told when they are at risk of working beyond ACGME duty-hour restrictions,” where 57 (34.7%) disagreed or strongly disagreed. Mean CFQ score was 16.02 (95% CI 14.87-17.17, N=113, 26.1%). As the CS score improved, CFQ scores decreased indicating an inverse relationship between duty-hour climate and fatigue (r=-0.328, p<0.05). Having a protected post-call day off, and having either the Program Director, Chief Resident, or Senior Resident decide that a resident takes a post-call day off were all associated with higher CS scores. Conclusion: We found that the CS had good internal consistency and evidence of construct validity. An inverse relationship between CS score and fatigue suggests that the level of fatigue is higher among residents in programs where residents perceived that ACGME duty-hour compliance was less important.
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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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Doebrich A, Quirici M, Lunsford C. COVID-19 and the need for disability conscious medical education, training, and practice. J Pediatr Rehabil Med 2020; 13:393-404. [PMID: 33252100 DOI: 10.3233/prm-200763] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.
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Affiliation(s)
- Adrienne Doebrich
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marion Quirici
- Thompson Writing Program, Duke University, Durham, NC, USA
| | - Christopher Lunsford
- Pediatric Rehabilitation Medicine, Department of Orthopaedics and Department of Pediatrics, Duke University, Durham, NC, USA
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Taylor TS, Raynard AL, Lingard L. Perseverance, faith and stoicism: a qualitative study of medical student perspectives on managing fatigue. MEDICAL EDUCATION 2019; 53:1221-1229. [PMID: 31657067 DOI: 10.1111/medu.13998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 05/25/2023]
Abstract
CONTEXT Fatigue risk management (FRM) strategies offer a potential solution to the widespread problem of fatigued trainees in the clinical workplace. These strategies assume a shared perception that fatigue is hazardous. Despite the growing body of evidence suggesting that fatigue leads to burnout and medical errors, previous research suggests that residents perceive fatigue as a personal, surmountable burden rather than an occupational hazard. Before we can implement FRM, we need a better understanding of when and how such problematic notions of fatigue are adopted by medical trainees. Thus, we sought to explore how third-year medical students understand and manage the workplace fatigue they experience during their first year of clinical rotations. METHODS A total of 22 third-year medical students participated in semi-structured interviews exploring their perspectives of workplace fatigue. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and were informed by theoretical sampling to sufficiency. RESULTS Our participants described unprecedented levels of sleep deprivation combined with uncertainty and confusion that led to significant fatigue during training. Drawing on their workplace experience, trainees believed that fatigue posed three distinct threats, which evoked different coping strategies: (i) threat to personal health, managed by perseverance; (ii) threat to patients, managed by faith in the system, and (iii) threat to professional reputation, managed by stoicism. CONCLUSIONS Our findings highlight how senior medical students grapple with fatigue, as they understand it, within a training context in which they are expected to deny the impact of their fatigue on patients and themselves. Despite empirical evidence to the contrary, the prevailing assumption amongst our participants is that an ability to withstand sleep deprivation without impairment will develop naturally over time. Efforts to implement FRM strategies will need to address this assumption if these strategies are to be successfully taken up and effective.
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Affiliation(s)
- Taryn S Taylor
- Department of Obstetrics and Gynaecology, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alexandra L Raynard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Macía-Rodríguez C, López Reboiro M, Martín Iglesias D, González-Munera A, Moreno Diaz J, Montaño Martínez A, Ortiz Llauradó G, Demelo-Rodríguez P, Muñoz Muñoz C, Salgado Ordoñez F. Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo. Rev Clin Esp 2019; 219:61-66. [DOI: 10.1016/j.rce.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/01/2018] [Accepted: 05/12/2018] [Indexed: 11/16/2022]
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Macía-Rodríguez C, López Reboiro M, Martín Iglesias D, González-Munera A, Moreno Diaz J, Montaño Martínez A, Ortiz Llauradó G, Demelo-Rodríguez P, Muñoz CM, Salgado Ordoñez F. Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hughes KE, Hughes PG, Hughes MJ. Sleep and Lifestyle Habits of Osteopathic Emergency Medicine Residents During Training. J Osteopath Med 2018; 118:e45-e50. [DOI: 10.7556/jaoa.2018.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Duty hours were enacted in 2003 with the intent to improve patient safety and resident well-being. However, limited data exist regarding improvements in residents’ well-being since the implementation of these restrictions.
Objective
To examine osteopathic emergency medicine (EM) resident characteristics regarding sleep and lifestyle habits and duty hour reporting.
Method
A convenience sample of osteopathic EM residents was surveyed at a statewide conference in May 2014. The conference included 177 residents from 15 osteopathic EM residencies. Data regarding demographics, sleep and lifestyle habits (including work-related motor vehicle incidents [MVIs] and chemical aid use for sleep/wakefulness), and duty hour reporting were collected. The Epworth Sleepiness Scale (ESS) score was calculated, with a score greater than 10 indicating sleep disturbance.
Results
Of the 128 residents (72%) who returned the survey, approximately two-thirds were female, were currently on an EM rotation, and were training in suburban emergency departments with more than 60,000 annual visits. Only 35% of respondents slept 8 or more hours per night during an EM rotation, and 63% admitted to weight change during residency. Forty-two percent of respondents had a work-related MVI, which was more likely to occur if their ESS score was greater than 11 (P<.03). Mean (SD) ESS score was 9.9 (4.8; range, 0-24). Respondents reported using chemical aids for staying awake or going to sleep on a mean (SD) of 6.9 (9.3) days per month (range, 0-30). The majority of respondents (84%) reported strict duty hour enforcement policies, few (17%) had ever been asked to falsify reports, and more than half (56%) had ever voluntarily reported false hours.
Conclusion
Most residents surveyed slept fewer than 8 hours per night and had a weight change during EM residency training. The majority of residents used a chemical aid for sleep or wakefulness. Nearly half of residents surveyed met criteria for disordered sleep, which was associated with a higher occurrence of MVIs.
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Huda N, Faden L, Goldszmidt M. Entrustment of the on-call senior medical resident role: implications for patient safety and collective care. BMC MEDICAL EDUCATION 2017; 17:121. [PMID: 28705161 PMCID: PMC5513049 DOI: 10.1186/s12909-017-0959-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/04/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND The on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR competency prior to granting these on-call responsibilities in internal medicine. In order to fulfill competency based medical education requirements, training programs need to develop assessment approaches to make and defend such entrustment decisions. The purpose of this study is to understand the clinical activities and outcomes of the on-call SMR role and provide training programs with a rigorous model for entrustment decisions for this role. METHODS This four phase study utilizes a constructivist grounded theory approach to collect and analyse the following data sets: case study, focus groups, literature synthesis of supervisory practices and return-of-findings focus groups. The study was conducted in two Academic Health Sciences Centres in Ontario, Canada. The case study included ten attending physicians, 13 SMRs, 19 first year residents and 14 medical students. The focus groups included 19 SMRs. The later, return-of-findings focus groups included ten SMRs. RESULTS Five core on-call supervisory tasks (overseeing ongoing patient care, briefing, case review, documentation and preparing for handover) were identified, as well as a range of practices associated with these tasks. We also identified challenges that influenced the extent to which SMRs were able to effectively perform the core tasks. At times, these challenges led to omissions of the core tasks and potentially compromised patient safety and the admission transition of care. CONCLUSION By identifying the core supervisory tasks and associated practices, we were able to identify the competencies for the on-call SMR role. Our findings can further be used by training programs for assessment and for making entrustment decisions.
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Affiliation(s)
- Noureen Huda
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- University Hospital, Room B9-105, London, ON N6A 5A5 Canada
| | - Lisa Faden
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition, Suite 110, N6A 5C1, London, ON Canada
| | - Mark Goldszmidt
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition, Suite 110, N6A 5C1, London, ON Canada
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Abstract
This AANS presidential address focuses on enduring values of the neurosurgical profession that transcend the current political climate. The address was delivered by Dr. Batjer during a US presidential election year, but the authors have intentionally avoided discussing the current chaos of the American health care system in the knowledge that many pressing issues will change depending on the outcome of the 2016 elections. Instead, they have chosen to focus on clarifying what neurosurgeons, and the American Association of Neurological Surgeons, in particular, stand for; identifying important challenges to these fundamental principles and values; and proposing specific actions to address these challenges. The authors cite "de-professionalism" and commoditization of medicine as foremost among the threats that confront medicine and surgery today and suggest concrete action that can be taken to reverse these trends as well as steps that can be taken to address other significant challenges. They emphasize the importance of embracing exceptionalism and never compromising the standards that have characterized the profession of neurosurgery since its inception.
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Affiliation(s)
- H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vin Shen Ban
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Taylor TS, Watling CJ, Teunissen PW, Dornan T, Lingard L. Principles of fatigue in residency education: a qualitative study. CMAJ Open 2016; 4:E200-4. [PMID: 27398364 PMCID: PMC4933638 DOI: 10.9778/cmajo.20150086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how residents understand fatigue in the context of their training environment. METHODS We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency. RESULTS Four predominant principles of fatigue captured how the social learning environment shaped residents' perceptions of fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required. INTERPRETATION This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational threat may have a limited impact on resident behaviour and patient safety.
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Affiliation(s)
- Taryn S Taylor
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Christopher J Watling
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Pim W Teunissen
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Tim Dornan
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Lorelei Lingard
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
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Maniatis T. Resident duty-hour reform: moving beyond "change for change's sake". CMAJ 2015; 187:309-10. [PMID: 25667251 DOI: 10.1503/cmaj.150010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Law MP, Orlando E, Baker GR. Organizational interventions in response to duty hour reforms. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S4. [PMID: 25558915 PMCID: PMC4304281 DOI: 10.1186/1472-6920-14-s1-s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. METHODS The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. RESULTS Twenty-five articles were included from the United States (n=18), the United Kingdom (n=5), Hong Kong (n=1), and Australia (n=1). They all described single-site projects; the majority used post-intervention surveys (n=15) and audit techniques (n=4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. CONCLUSIONS Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.
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Affiliation(s)
- Madelyn P Law
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Imrie KR, Frank JR, Parshuram CS. Resident duty hours: past, present, and future. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S1. [PMID: 25559868 PMCID: PMC4304261 DOI: 10.1186/1472-6920-14-s1-s1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Kevin R Imrie
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - Jason R Frank
- The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- The Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher S Parshuram
- The University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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