Nuthalapaty Francis S, Carver Alissa R, Nuthalapaty Elizabeth S, Ramsey Patrick S
Department of Obstetrics and Gynecology, Center for Research in Women's Health, University of Alabama, Birmingham, USA.
Am J Obstet Gynecol. 2006 Jun;194(6):1556-62. doi: 10.1016/j.ajog.2005.10.215. Epub 2006 Apr 21.
The purpose of this study was to characterize residency program director baseline perceptions regarding the effect of resident duty hour limitations on key components of the graduate medical education environment.
This was a survey of directors of accredited obstetrics and gynecology residency programs in the United States (excluding New York State) between June 21st and July 16th, 2004. Participants were queried on views regarding the need for duty hour limitations, and the perceived effect of these changes on various issues related to the residency environment.
Fifty-eight percent (123/211) of the study population completed the questionnaire. Seventy-one percent of respondents supported duty hour restrictions, 19% opposed restrictions, and 10% were undecided. Forty-one percent of respondents preferred a maximum duty hour limitation of 80 hrs/wk or less, 55% preferred one at least 90 hrs/wk, and 4% preferred no upper limit. A significantly greater proportion of female program directors supported limits > 80 hrs/wk than males (73% vs 53%, P = .04). A majority of participants believed resident education, surgical skills, and work ethic have been negatively impacted by the limitations, while patient safety and the overall quality of patient care have remained unchanged or declined, and resident well-being has improved. Opposition to duty hour regulations and a preference for higher limits was associated with a higher prevalence of negative impressions regarding the impact of duty hour regulations on the residency environment.
Variations in current opinions regarding the impact of residency duty hour restrictions reflect ongoing bias in those most influential to resident education.
本研究旨在描述住院医师培训项目主任对于住院医师值班时间限制对毕业后医学教育环境关键组成部分影响的基线认知。
这是一项于2004年6月21日至7月16日对美国（不包括纽约州）经认可的妇产科住院医师培训项目主任进行的调查。就值班时间限制的必要性以及这些变化对与住院医师培训环境相关的各种问题的感知影响向参与者进行了询问。
58%（123/211）的研究人群完成了问卷。71%的受访者支持值班时间限制，19%反对限制，10%未作决定。41%的受访者倾向于每周最多80小时或更少的值班时间限制，55%倾向于至少每周90小时的限制，4%倾向于不设上限。女性项目主任中支持每周超过80小时限制的比例显著高于男性（73%对53%，P = 0.04）。大多数参与者认为住院医师教育、手术技能和职业道德受到了这些限制的负面影响，而患者安全和患者护理的总体质量保持不变或有所下降，住院医师的幸福感有所提高。对值班时间规定的反对以及对更高限制的偏好与对值班时间规定对住院医师培训环境影响的负面印象的较高发生率相关。
目前对于住院医师值班时间限制影响的观点差异反映了在对住院医师教育最具影响力的人群中持续存在的偏见。
