Breen Elizabeth, Irani Jennifer L, Mello Michelle M, Whang Edward E, Zinner Michael J, Ashley Stanley W
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Curr Surg. 2005 Sep-Oct;62(5):543-6. doi: 10.1016/j.cursur.2005.05.002.
New Accreditation Council for Graduate Medical Education (ACGME) resident duty hour requirements were implemented in July 2003. A recent study suggests that these requirements have resulted in substantial work-hour reductions and improvements in quality of life for general surgery residents. The impact of these changes on the culture of surgery and attitudes about future practice patterns among current surgical residents is unknown.
To characterize future practice patterns desired by the current generation of general surgery residents.
A confidential survey was administered to all residents enrolled in 21 general surgery residency programs in New England (n = 668).
Completed responses were received from 238 residents. Three quarters of the respondents wish to limit their practice to a subspecialty, and two thirds wish to work 60 hours or less per week as attending surgeons. About one quarter find a job-sharing arrangement desirable. Seventy-one percent report that being on-call for their patients at all times with no night or weekend cross-coverage would be undesirable. Over 90% desire sharing on-call responsibilities with members of a group. Over one quarter would feel comfortable allowing cross-covering colleagues to manage their operative complications routinely, including reoperation. Over one quarter would pass off a scheduled operation that was delayed into the night or weekend.
The current surgical residents desire practice patterns that substantially differ from those of today's surgeons. To the extent that these attitudes spring from changes in resident working conditions wrought by the ACGME duty hour requirements, these requirements have the potential to change the nature of surgical practice in this country.
新的毕业后医学教育认证委员会（ACGME）住院医师值班时间要求于2003年7月开始实施。最近一项研究表明，这些要求已大幅减少了工作时间，并改善了普通外科住院医师的生活质量。这些变化对外科文化以及当前外科住院医师对未来执业模式的态度的影响尚不清楚。
描述当代普通外科住院医师期望的未来执业模式。
对新英格兰地区21个普通外科住院医师培训项目中的所有住院医师进行了一项保密调查（n = 668）。
收到了238名住院医师的完整回复。四分之三的受访者希望将自己的执业范围限制在一个亚专业领域，三分之二的受访者希望作为主治医生时每周工作60小时或更少。约四分之一的人认为工作分担安排是可取的。71%的人表示，随时为患者待命且没有夜间或周末交叉值班是不可取的。超过90%的人希望与团队成员分担值班职责。超过四分之一的人会放心地让交叉值班的同事常规处理他们的手术并发症，包括再次手术。超过四分之一的人会将推迟到夜间或周末的预定手术交接给他人。
当前的外科住院医师期望的执业模式与当今外科医生的模式有很大不同。如果这些态度源于ACGME值班时间要求带来的住院医师工作条件的变化，那么这些要求有可能改变该国外科执业的性质。
