Kupferman Todd A, Lian Tim S
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center-Shreveport, USA.
Otolaryngol Head Neck Surg. 2005 Jun;132(6):819-22. doi: 10.1016/j.otohns.2005.03.004.
To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States.
Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States.
Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions.
According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents.
This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.
从项目主任的角度确定最近实施的值班时间标准对耳鼻咽喉 - 头颈外科住院医师培训项目产生了何种影响（若有影响的话）。我们假设住院医师值班时间限制的实施已导致美国耳鼻咽喉科培训项目发生变化。
通过前瞻性、盲法调查，从美国耳鼻咽喉 - 头颈住院医师培训项目的项目主任处收集信息。
总体而言，77% 的受访者认为住院医师值班时间限制并未改善耳鼻咽喉 - 头颈外科住院医师培训。71% 做出回应的项目中，值班时间限制已导致住院医师工作安排发生变化。约一半的住院医师对工作时间变化持积极态度。32% 的受访者表示需要对耳鼻咽喉科支持人员做出调整，其中许多项目雇佣了医师助理。84% 的受访者认为住院医师值班时间限制并未改善患者护理，81% 的受访者认为这对住院医师培训经历产生了负面影响。45% 的项目主任认为耳鼻咽喉 - 头颈科教员被迫增加工作量，以适应住院医师参与临床活动时间的减少。54% 的项目从院内值班改为居家值班以适应值班时间限制。
根据参与调查的大多数耳鼻咽喉 - 头颈外科项目主任的看法，美国毕业后医学教育认证委员会（ACGME）对住院医师值班时间的限制并未改善住院医师培训，未改善患者护理，且降低了住院医师的培训经历。
本研究表明，由于ACGME规定的工作时间限制，耳鼻咽喉 - 头颈外科培训项目已做出多项改变。
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