1
|
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 2023; 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] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
Tarrash M, Nelson D, Gabbur N, Goldberg GL. Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital. BMC MEDICAL EDUCATION 2022; 22:809. [PMID: 36424600 PMCID: PMC9686460 DOI: 10.1186/s12909-022-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout. OBJECTIVE To determine the rates of burnout among residents working night rotations versus day rotations. METHODS This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test. RESULTS A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights. CONCLUSIONS Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.
Collapse
Affiliation(s)
- Miriam Tarrash
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - David Nelson
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Nagaraj Gabbur
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA
| | - Gary L Goldberg
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and Northwell Health, New York, USA.
- Department of Obstetrics & Gynecology LIJ Medical Center, Ob/Gyn Admin Suite Room C221, 270-05 76th Avenue, New Hyde Park, New York, NY, 11040, USA.
| |
Collapse
|
3
|
Bowden SG, Siler DA, Shahin MN, Mazur-Hart DJ, Munger DN, Ross MN, O’Neill BE, Nerison CS, Rothbaum M, Han SJ, Wright JM, Orina JN, Winer JL, Selden NR. Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.5.focus22181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems.
METHODS
The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020. The authors analyzed the volumes of new patient consultations, bedside procedures, and operative procedures performed by each PGY-2 and PGY-3 resident during these years, comparing the volumes experienced under each call system.
RESULTS
Changing from a PGY-2 resident–focused night-float call system to a 24-hour call system that was more evenly distributed between PGY-2 and PGY-3 residents resulted in decreased volume of new patient consultations, increased volume of operative procedures, and no change in volume of bedside procedures for PGY-2 residents. PGY-3 residents experienced a decrease in operative procedure volume under the 24-hour call system.
CONCLUSIONS
Transition from a night-float system to a 24-hour call system altered the distribution of clinical and procedural experiences between PGY-2 and PGY-3 residents. Further research is necessary to understand the impact of these changes on educational outcomes, quality and safety of patient care, and resident satisfaction.
Collapse
Affiliation(s)
- Stephen G. Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Dominic A. Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Maryam N. Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Daniel N. Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Miner N. Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Brannan E. O’Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Caleb S. Nerison
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Seunggu J. Han
- Department of Neurosurgery, Stanford University, Palo Alto, California
| | - James M. Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Josiah N. Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Jesse L. Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Nathan R. Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| |
Collapse
|
4
|
McGahan BG, Hatef J, Shaikhouni A, Leonard J, Grossbach AJ, Lonser RR, Powers CJ. Resident Night Float or 24-hour Call Hospital Coverage: Impact on Training, Patient Outcome, and Length of Stay. JOURNAL OF SURGICAL EDUCATION 2022; 79:732-739. [PMID: 34866033 DOI: 10.1016/j.jsurg.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The impact of neurosurgical resident hospital coverage system, performed via a night float (12-hour shifts overnight) or a 24-hour call, on neurological surgery resident training and patient care is unknown. DESIGN Retrospective review comparing night float and 24-hour call coverage on trainee surgical experience, elective time, annual program surveys, patient outcomes, and length of stay. SETTING The Ohio State Wexner Medical Center Neurosurgery residency program, Columbus, Ohio. PARTICIPANTS The neurosurgical residents from 2016 to 2019. RESULTS Monthly cases performed by junior residents significantly increased after transitioning to a 24-hour call schedule (18 versus 30, p < 0.001). There were no differences for total cases among program graduates during this time (p = 0.7). Trainee elective time significantly increased after switching to 24-hour call coverage (18 versus 24 months after the transition; p = 0.004). Risk-adjusted mortality and length of stay indices were not different (0.5 versus 0.3, p = 0.1; 0.9 versus 0.9; p = 0.3). Program surveys had minimal change after the transition to 24-hour call. CONCLUSIONS Transitioning from a night float to a 24-hour call coverage system led to improved junior resident case volume and elective time without detrimental effect on patient-related outcomes.
Collapse
Affiliation(s)
- Ben G McGahan
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jeffrey Hatef
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ammar Shaikhouni
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey Leonard
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew J Grossbach
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Russell R Lonser
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ciaran J Powers
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
5
|
Kelly PD, Yengo-Kahn AM, Roth SG, Zuckerman SL, Chitale RV, Wellons JC, Chambless LB. Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs. Neurosurgery 2021; 89:750-759. [PMID: 34423828 DOI: 10.1093/neuros/nyab322] [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: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed. OBJECTIVE To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research. METHODS A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance. RESULTS From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described. CONCLUSION Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.
Collapse
Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Chapman KD, Badami V, Stawovy L, Ali S, Abdelfattah M. Transition to an In-House Night Float System for Critical Care Fellows: Resident Experience, Morbidity, and Mortality in a Rural Academic Hospital. Cureus 2021; 13:e17200. [PMID: 34540428 PMCID: PMC8439410 DOI: 10.7759/cureus.17200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background In-house night call systems for ICUs are frequently implemented to enable hands-on patient care and provide direct supervision of resident physicians at night. Previous studies have highlighted the benefits of an in-house night float (NF) such as minimized time to intervention but failed to consistently demonstrate an improvement in patient outcomes. This study aimed to evaluate the impact of an in-house critical care fellow at night on the resident experience and assess for impact on patient morbidity and mortality. Methods An in-house overnight critical care fellow shift was implemented at West Virginia University Hospital in 2018. Resident physicians rotating overnight in the medical ICU (MICU) for six-month periods before and after the intervention were anonymously surveyed. A retrospective chart review of 300 patients admitted overnight to the MICU was performed. Multiple patient outcomes from the pre (2017) and post (2018) intervention periods were collected and compared using a two-sample t-test. Results In the post-intervention survey, nearly every element of resident experience improved (availability of support, comfort in performing invasive procedures, and input in treatment plans), and far fewer residents felt overwhelmed relative to the pre-intervention survey. The resident experience markedly improved with the addition of an in-house critical care fellow. For the retrospective chart review, both groups had similar severity of illness and there was no change in ICU or hospital length of stay. No difference in mortality was found, though the study was underpowered for this outcome. For secondary measures, there was no difference in mechanical ventilation or use days, though more procedures performed were overnight compared to the former staffing model. Conclusions Implementation of an in-house overnight critical care fellow shift in the MICU positively impacted resident experience without worsening patient outcomes. The intervention did not worsen measures of morbidity or mortality but did lead to an increased number of procedures performed overnight. The model of in-house NF coverage continues to be preferred by clinicians.
Collapse
Affiliation(s)
- Kyle D Chapman
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Varun Badami
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Lauren Stawovy
- Medicine/Pulmonary and Critical Care, West Virginia University School of Medicine, Morgantown, USA
| | - Sana Ali
- Medicine/Pulmonary and Critical Care, Albany Medical Center, Albany, USA
| | - Mohamad Abdelfattah
- Medicine/Pulmonary and Critical Care, Martin Luther King, Jr. Community Hospital, Los Angeles, USA
| |
Collapse
|
7
|
Heo R, Park CW, You CJ, Choi DH, Park K, Kim YB, Kim WK, Yee GT, Kim MJ, Oh JH. Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea. J Cerebrovasc Endovasc Neurosurg 2020; 22:245-257. [PMID: 33307619 PMCID: PMC7820262 DOI: 10.7461/jcen.2020.e2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To compare short-term treatment outcomes at hospital discharge and hospital length of stay (LOS) in patients with spontaneous intracerebral hemorrhage (sICH) before and after introduction of resident physician work time limit (WTL). Methods We retrospectively reviewed consecutive patients treated for sICH at our institution between 2016 and 2019. Then we dichotomized these patients into two groups, pre-WTL and post-WTL. We analyzed demographic elements and clinical features, and hospital length of stay (LOS). We evaluated short-term outcome using modified Rankin scale score at hospital discharge and then divided it into “good” and “poor” outcome groups. We subsequently, compared short-term treatment outcome and hospital LOS between the pre-WTL and post-WTL groups. Results Out of 779 patients, 420 patients (53.9%) were included in the pre-WTL group, and 359 (46.1%) in post-WTL. The mortality rate in sICH patients was higher in the post-WTL group (pre-WTL; 13.6% vs. post-WTL; 17.3%), but there was no statistically significant difference in short-term outcome including mortality (p=0.332) between the groups. The LOS also, was not significantly different between the two groups (pre-WTL; 19.0 days vs. post-WTL; 20.2 days) (p=0.341). The initial Glasgow Coma Scale score, personal stroke history, and mean age were the only independent outcome predicting factors for patients with sICH. Conclusions Some neurosurgeons may expect poorer outcome for sICH after implementation of the WTL of the K-MHW for resident physician however, enforcement of the WTL did not significantly influence the short-term outcome and hospital LOS for sICH in our hospital. Further well-designed multi-institutional prospective studies on the effects of WTL in sICH patient outcome, are anticipated.
Collapse
Affiliation(s)
- Rojin Heo
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Chan Jong You
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kwangwoo Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Young Bo Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gi-Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Myeong-Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jin-Hwan Oh
- Integrative Medicine Research Institute, Jangheung Integrative Medical Hospital, Wonkwang University, Jangheung, Korea
| |
Collapse
|
8
|
Loo BKG, Ng CL, Chin RT, Davies LJ, Yong J, Ang AEL, Chong YW, Tambyah PA. Nationwide survey comparing residents' perceptions of overnight duty systems in Singapore: night float versus full overnight call. Singapore Med J 2020; 61:559-562. [PMID: 33225371 DOI: 10.11622/smedj.2020149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Benny Kai Guo Loo
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Chew Lip Ng
- Department of Ear, Nose & Throat - Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore
| | - Run Ting Chin
- Department of Endocrine, National University Hospital, Singapore
| | | | - Jin Yong
- Department of Urology, Singapore General Hospital, Singapore
| | | | | | | |
Collapse
|
9
|
Alsohime FM. Pediatric residents' perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey. Saudi Med J 2020; 40:1040-1044. [PMID: 31588484 PMCID: PMC6887876 DOI: 10.15537/smj.2019.10.24548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To examine pediatric residents’ perceptions of the 24-hour in-hospital shift and its impact on their well-being and education and patient safety. Methods: A cross-sectional survey conducted with residents enrolled in pediatric residency programs across Saudi Arabia in February 2017 at the Saudi Commission For Health Specialties, Riyadh Saudi Arabia. We designed a self-administered questionnaire that was distributed using the Saudi Commission for Health Specialties E-mail groups. A 4-point Likert-type scale was used to rank the residents’ responses; and the relative importance index (RII) approach was used to analyze the relative contribution of each indicator to its main theme. Results: A total of 314 residents participated in the survey (response rate, 30%). Of these, 168 (53.6%) were females. When asked about their preferences regarding the 24-hour on-call system, 286 residents (91.1%) preferred not to continue with this system. Residents ranked several indicators that they perceived as a negative impact due to the 24-hour on-call system. The first ranked indicator was missing academic activities and elective rotations post-call (mean 3.10 [standard deviation 1.25], RII 90.94%), and the second was decreased performance and decision-making skills during night duty (mean 3.51 [standard deviation 1.0], RII 88.11%). Conclusion: We found that the 24-hour on-call system negatively impacts residents’ well-being and education and patient care. Pediatric residency training programs in Saudi Arabia should consider resident duty hour reform and evaluate new on-call models to improve resident well-being and training, as well as patient care.
Collapse
Affiliation(s)
- Fahad M Alsohime
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
10
|
Gordon WE, Gienapp AJ, Jones M, Michael LM, Klimo P. An Analysis of the On-Call Clinical Experience of a Junior Neurosurgical Resident. Neurosurgery 2018; 85:290-297. [DOI: 10.1093/neuros/nyy248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
The process of transforming a medical student to a competent neurosurgeon is becoming increasingly scrutinized and formalized. However, there are few data on resident workload.
We sought to quantify the workload and educational experience of a junior resident while “on-call.”
A single resident's on-call log was reviewed from the period of July 1, 2014 to June 30, 2016, corresponding to that resident's postgraduate years 2 and 3. For each patient encounter (ie, consult or admission), information pertaining to the patient's demographics, disease or reason for consult, date/time/location of consult, and need for any neurosurgical intervention within the first 24 hours was collected.
In total, 1929 patients were seen in consultation. The majority of patients were male (62%) with a median age of 50 years (range, day of life 0-102 years) and had traumatic diagnoses (52%). The number of consults received during the 16:00 to 17:00 and 17:00 to 18:00 hours was +1.6 and +2.5 standard deviations above the mean, respectively. The busiest and slowest months were May and January, respectively. Neurosurgical intervention performed within the first 24 hours of consultation occurred in 330 (17.1%) patients: 221 (11.4%) major operations, 69 (3.6%) external ventricular drains, and 40 (2.1%) intracranial pressure monitors.
This is the first study to quantify the workload and educational experience of a typical neurosurgical junior resident while “on-call” (ie, carrying the pager) for 2 consecutive years. It is our hope that these findings are considered by neurosurgical educators when refining resident education.
Collapse
Affiliation(s)
- William E Gordon
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Department of Medical Education, Methodist University Hospital, Memphis, Tennessee
| | - Morgan Jones
- Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| |
Collapse
|
11
|
Mattei TA, Ordookhanian C, Kaloostian PE. "Dear Anesthesiologist, Please Don't Abandon Us": Excessive Anesthesia Handovers and Adverse Perioperative Outcomes in Neurosurgery. World Neurosurg 2018; 115:254-256. [PMID: 29772360 DOI: 10.1016/j.wneu.2018.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Tobias A Mattei
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA.
| | - Christ Ordookhanian
- University of California, Riverside, School of Medicine, Riverside, California, USA
| | - Paul E Kaloostian
- University of California, Riverside, School of Medicine, Riverside, California, USA
| |
Collapse
|
12
|
Savel RH, Cohen W, Borgia D, Simon RJ. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management. J Emerg Trauma Shock 2018; 11:65-70. [PMID: 29628674 PMCID: PMC5852922 DOI: 10.4103/jets.jets_9_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care.
Collapse
Affiliation(s)
- Richard H Savel
- Maimonides Medical Center, Adult Critical Care Services, Brooklyn, New York, USA
| | - Wess Cohen
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Dena Borgia
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ronald J Simon
- Division of Acute Care Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| |
Collapse
|
13
|
Is Time of ICU Admission a Surrogate for System Factors Impacting Patient Mortality? Pediatr Crit Care Med 2017; 18:986-987. [PMID: 28976461 DOI: 10.1097/pcc.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|