Jagsi Reshma, Shapiro Jo, Weinstein Debra F
Office for Graduate Medical Education, Bulfinch 2, Massachusetts General Hospital, 10 Fruit Street, Boston, MA 02114, USA.
Acad Med. 2005 Aug;80(8):752-7. doi: 10.1097/00001888-200508000-00011.
To assess medical students' perceptions of the impact of recent Accreditation Council for Graduate Medical Education policies limiting resident work hours on students' clerkship experiences, resident teaching, and quality of patient care.
In May/June 2003 and May/June 2004, an original questionnaire was administered to 252 medical students completing required clinical rotations at two teaching hospitals to assess students' perceptions of endpoints that might be affected by resident work hours limits. Response data were analyzed to determine statistical significance of differences between the two years studied.
Questionnaires were completed by 129 students in 2003 (98%) and 112 students in 2004 (93%), for an overall response rate of 96%. A higher proportion of students perceived limits on work hours in 2004 [46 (41%)] than 2003 [36 (28%), p = .03]. Ratings of resident availability and primary resident's interest in teaching improved in 2004. Otherwise, ratings of the interest, skill, and availability of resident teachers and attending physicians remained stable between 2003 and 2004. Students reported spending similar amounts of time in formal teaching sessions and rated feedback similarly between 2003 and 2004. In 2004, fewer students [28 (25%)] reported considering leaving medicine due to long hours in training than in 2003 [49 (38%), p = .04]. No significant differences in the proportion of students reporting suboptimal care were found [44 (34%) in 2003, 34 (35%) in 2004, p = .57].
This small, early study suggests that reductions in resident work hours might be implemented without a significant negative impact upon medical students' self-assessed learning experiences, and that limiting resident work hours may even have a positive impact on medical students.
评估医学生对毕业后医学教育认证委员会（Accreditation Council for Graduate Medical Education）近期限制住院医师工作时长的政策对学生临床实习经历、住院医师教学及患者护理质量影响的看法。
在2003年5月/6月和2004年5月/6月，向在两家教学医院完成规定临床轮转的252名医学生发放原始问卷，以评估学生对可能受住院医师工作时长限制影响的终点指标的看法。对回复数据进行分析，以确定所研究的两年间差异的统计学显著性。
2003年有129名学生（98%）完成问卷，2004年有112名学生（93%）完成问卷，总体回复率为96%。2004年感觉工作时长受限的学生比例[46名（41%）]高于2003年[36名（28%），p = 0.03]。2004年住院医师的可及性及主治住院医师的教学兴趣评分有所提高。除此之外，2003年至2004年期间，住院医师教师和主治医师的兴趣、技能及可及性评分保持稳定。2003年至2004年，学生报告在正式教学课程中花费的时间相近，且对反馈的评分相似。2004年，因培训时长过长而考虑放弃医学的学生[28名（25%）]少于2003年[49名（38%），p = 0.04]。报告护理欠佳的学生比例无显著差异[2003年为44名（34%），2004年为34名（35%），p = 0.57]。
这项小型的早期研究表明，减少住院医师工作时长的措施在实施时可能不会对医学生自我评估的学习经历产生重大负面影响，而且限制住院医师工作时长甚至可能对医学生产生积极影响。
