Resnick Andrew S, Todd Barbara A, Mullen James L, Morris Jon B
Surgery Education, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Surg. 2006 Mar-Apr;63(2):155-64. doi: 10.1016/j.cursur.2005.12.009.
The reduction of resident work hours due to the 80-hour workweek has created pressure on academic health-care systems to find "replacement residents." At the authors' institution, a group of nurse practitioners (NPs) and physician assistants (PAs), collectively referred to as non-physician practitioners (NPPs), were hired as these reinforcements, such that the number of NPPs (56) was almost twice the number of clinical categorical surgery residents (37). An experienced leader with national credibility was hired to run the NPP program. On each service, the call system was changed to a night float system, whereby residents were pulled from traditional resident teams to serve as nighttime residents during the week. A total of 1-3 NPPs were hired for each team, but whether NPPs worked for the team as a whole, or were assigned to individual attendings, was left to the discretion of the division chiefs. One year after the start of this program, the authors wanted to study the effects it has had on both surgery resident education and NPP job satisfaction.
An electronic, anonymous survey was conducted during a monthly surgery resident meeting, and out of 72 categorical and preliminary surgery residents, 50% submitted answers to 12 questions. A similar electronic survey was administered to all 56 NPPs, with 45% responding.
Overall, 63% of residents believed that lines of communication between surgery team members were clear, and 58% of residents and 71% of NPPs believed that attendings, residents, and NPPs worked together effectively. A total of 91% of residents believed that the addition of NPPs to the teams was positive overall, and 80% of NPPs were satisfied with their positions. Overall, 60% of residents and 50% of NPPs felt that educational goals were being met.
Implementation of the 80-hour workweek and introduction of NPs and PAs onto the inpatient surgical services has altered resident education at the authors' institution. Although overall most residents view the addition of NPPs to the clinical services as positive, there are concerns about the program. Although hired to fill the void left by decreasing labor hours of residents, NPPs do not necessarily have the same goals as surgery residents and there is confusion about how NPPs fit into the hierarchy of the traditional surgical team.
由于实行每周80小时工作制，住院医师工作时长减少，这给学术医疗系统带来了压力，迫使其寻找“替代住院医师”。在作者所在的机构，一组护士执业医师（NPs）和医师助理（PAs），统称为非医师执业人员（NPPs），被雇用来作为补充力量，NPPs的数量（56人）几乎是临床分类外科住院医师数量（37人）的两倍。聘请了一位在全国具有公信力的经验丰富的领导者来管理NPP项目。在每个科室，呼叫系统改为夜间轮值系统，即从传统的住院医师团队中抽调住院医师在一周内担任夜间住院医师。每个团队共聘请了1 - 3名NPPs，但NPPs是为整个团队工作，还是被分配给各个主治医师，由科室主任自行决定。该项目启动一年后，作者希望研究其对外科住院医师教育和NPP工作满意度的影响。
在每月一次的外科住院医师会议期间进行了一项电子匿名调查，在72名分类和初步外科住院医师中，50%回答了12个问题。对所有56名NPPs进行了类似的电子调查，45%做出了回应。
总体而言，63%的住院医师认为外科团队成员之间的沟通渠道清晰，58%的住院医师和71%的NPPs认为主治医师、住院医师和NPPs之间合作有效。共有91%的住院医师认为团队中增加NPPs总体上是积极的，80%的NPPs对自己的职位感到满意。总体而言，60%的住院医师和50%的NPPs认为教育目标正在实现。
每周80小时工作制的实施以及将NPs和PAs引入住院外科服务，改变了作者所在机构的住院医师教育。尽管总体上大多数住院医师认为临床服务中增加NPPs是积极的，但对该项目仍存在担忧。尽管NPPs被雇用来填补住院医师劳动时间减少所留下的空缺，但他们的目标不一定与外科住院医师相同，而且对于NPPs如何融入传统外科团队的层级结构存在困惑。
