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工作时间改革:当代外科住院医师的看法与期望

Work hours reform: perceptions and desires of contemporary surgical residents.

作者信息

Whang Edward E, Perez Alexander, Ito Hiromichi, Mello Michelle M, Ashley Stanley W, Zinner Michael J

机构信息

Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.

出版信息

J Am Coll Surg. 2003 Oct;197(4):624-30. doi: 10.1016/S1072-7515(03)00602-1.

Abstract

BACKGROUND

New Accreditation Council for Graduate Medical Education (ACGME) requirements on resident duty hours are scheduled to undergo nationwide implementation in July 2003. General surgery residents, because of their long duty hours, are likely to be among those most affected by changes imposed to comply with the ACGME requirements. There are few contemporary data on their attitudes toward work hours reform.

STUDY DESIGN

The study entailed a region-wide survey of residents enrolled in general surgery residencies in New England to characterize the perceptions and desires of surgical residents on the issue of work hours reform.

RESULTS

Respondents reported working a mean of 105 +/- 0.7 hours per week, considerably more than the 80-hour limit stipulated by the ACGME. Of the respondents, 81% reported that sleep deprivation had negatively affected their work. A strong majority of respondents believe that work hours reform would improve their quality of life but less than one half expect it to have a positive impact on patient care. A greater percentage of senior residents than junior residents (p < 0.05) have negative perceptions of work hour limitations, particularly with respect to consequences for patient care. Other findings suggest that residents who have actually experienced work hour restrictions are less positive about such restrictions than these residents who had not yet experienced them.

CONCLUSIONS

Changes imposed by residency programs to comply with work hour requirements might have detrimental effects on senior residents and patient care. The impact of such changes should be carefully monitored as the ACGME requirements are implemented.

摘要

背景

研究生医学教育认证委员会(ACGME)对住院医师值班时长的新要求计划于2003年7月在全国范围内实施。普通外科住院医师由于值班时间长,可能是受为符合ACGME要求而实施的变革影响最大的群体之一。关于他们对工作时长改革态度的当代数据很少。

研究设计

该研究对新英格兰地区参加普通外科住院医师培训项目的住院医师进行了全区范围的调查,以了解外科住院医师对工作时长改革问题的看法和期望。

结果

受访者报告平均每周工作105±0.7小时,大大超过了ACGME规定的80小时上限。在受访者中,81%报告睡眠不足对其工作产生了负面影响。绝大多数受访者认为工作时长改革会改善他们的生活质量,但不到一半的人期望这会对患者护理产生积极影响。与低年资住院医师相比,高年资住院医师(p<0.05)对工作时长限制的看法更消极,尤其是在对患者护理的影响方面。其他研究结果表明,实际经历过工作时长限制的住院医师对这些限制的态度不如尚未经历过的住院医师积极。

结论

住院医师培训项目为符合工作时长要求而做出的改变可能会对高年资住院医师和患者护理产生不利影响。随着ACGME要求的实施,应仔细监测这些变化的影响。

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