专科培训、工作量、疲劳与身体应激：一项前瞻性观察性研究。
Fellowship training, workload, fatigue and physical stress: a prospective observational study.
作者信息
Parshuram Christopher S, Dhanani Sonny, Kirsh Joel A, Cox Peter N
机构信息
Department of Critical Care Medicine, Hospital for Sick Children, Tornto, ON.
出版信息
CMAJ. 2004 Mar 16;170(6):965-70. doi: 10.1503/cmaj.1030442.
BACKGROUND
Fatigue in physician trainees may compromise patient safety and the well-being of the trainees and limit the educational opportunities provided by training programs. Anecdotal evidence suggests that the on-call workload and physical demands experienced by trainees are significant despite duty-hour regulation and support from nursing staff, other trainees and staff physicians.
METHODS
We measured the workload and the level of fatigue and physical stress of 11 senior fellows during 35 shifts in the critical care unit at the Hospital for Sick Children in Toronto. We determined number of rostered hours, number of admissions and discharges, number and type of procedures, nurse:patient ratios and related measures of workload. Fellows self-reported the number of pages they received and the amount of time they slept. We estimated physical stress by using a commercially available pedometer to measure the distance walked, by using ambulatory electrocardiographic monitoring to determine arrhythmias and by determining urine specific gravity and ketone levels to estimate hydration.
RESULTS
The number of rostered hours were within current Ontario guidelines. The mean shift duration was 25.5 hours (range 24-27 hours). The fellows worked on average 69 hours (range 55-106) per week. On average during a shift, the fellows received 41 pages, were on non-sleeping breaks for 1.2 hours, slept 1.9 hours and walked 6.3 km. Ketonuria was found in participants in 7 (21%) of the 33 shifts during which it was measured. Arrhythmia (1 atrial, 1 ventricular) or heart rate abnormalities occurred in all 6 participants. These fellows were the most senior in-house physician for a mean of 9.4 hours per shift and were responsible for performing invasive procedures in two-thirds of their shifts.
INTERPRETATION
Established Canadian and proposed American guidelines expose trainees to significant on-call workload, physical stress and sleep deprivation.
背景
医学生的疲劳可能会危及患者安全以及学生自身的健康，并限制培训项目所提供的教育机会。轶事证据表明，尽管有值班时间规定以及护士、其他学生和带教医生的支持，但学生所经历的值班工作量和体力要求仍然很大。
方法
我们对多伦多病童医院重症监护病房的11名高级研究员在35个班次期间的工作量、疲劳程度和身体压力水平进行了测量。我们确定了排班时长、入院和出院人数、操作的数量和类型、护士与患者的比例以及相关的工作量指标。研究员自行报告他们收到的传呼次数和睡眠时间。我们通过使用市售计步器测量行走距离、通过动态心电图监测确定心律失常以及通过测定尿比重和酮水平来估计水合作用，从而估算身体压力。
结果
排班时长符合安大略省目前的指导方针。平均轮班时长为25.5小时（范围为24 - 27小时）。研究员平均每周工作69小时（范围为55 - 106小时）。在一个班次期间，研究员平均收到41次传呼，非睡眠时间休息1.2小时，睡眠1.9小时，行走6.3公里。在测量酮尿症的33个班次中的7个（21%）班次的参与者中发现了酮尿症。所有6名参与者均出现心律失常（1例房性、1例室性）或心率异常。这些研究员平均每班作为最资深的住院医生工作9.4小时，并且在三分之二的班次中负责进行侵入性操作。
解读
加拿大既定的以及美国提议的指导方针使实习生面临大量的值班工作量、身体压力和睡眠剥夺。
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