Brunworth Joseph D, Sindwani Raj
Department of Otolaryngology-Head & Neck Surgery, St. Louis University School of Medicine, St. Louis, MO 63110, USA.
Laryngoscope. 2006 Jul;116(7):1127-30. doi: 10.1097/01.mlg.0000224348.44616.fb.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) passed a controversial mandate limiting resident work hours. We sought to examine the impact of these restrictions on otolaryngology programs and to explore faculty and resident perspectives.
Faculty and residents of all 102 ACGME-accredited otolaryngology residency programs were invited to participate in an anonymous online survey.
The study population consisted of 460 respondents: 275 residents and 185 faculty (including 41 program directors) representing 57 otolaryngology programs. Sixty-five percent of programs implemented at least one change specifically to comply with duty-hour restrictions. Strategies included tracking work hours electronically (35.7%), utilization of "home call" (33.1%), and hiring additional healthcare professionals (23.1%). When asked if the restrictions have had a negative effect on patient care, 61% of respondents said no, but a surprising 33% said yes. Sixty-nine percent of faculty felt that the restrictions have actually had a negative effect on resident training compared with only 31% of residents (P<.001). Thirty-nine percent of participants felt resident workload was excessive before the restrictions. Opinions on whether duty-hour limits had fostered improvements in resident education, research, or examination scores varied, but most agreed that resident mental health had improved (67%).
Otolaryngology programs have successfully restricted resident duty hours through significant infrastructural changes. Of concern, the majority of residents surveyed appeared to be in favor of the ACGME restrictions, whereas most program directors and faculty were opposed. Further studies are needed to establish whether limited work hours will enhance or hinder the residency training experience.
2003年，毕业后医学教育认证委员会（ACGME）通过了一项有争议的指令，限制住院医师的工作时长。我们试图研究这些限制对耳鼻喉科住院医师培训项目的影响，并探讨教职员工和住院医师的观点。
邀请了所有102个经ACGME认证的耳鼻喉科住院医师培训项目的教职员工和住院医师参与一项匿名在线调查。
研究人群包括460名受访者：275名住院医师和185名教职员工（包括41名项目主任），代表57个耳鼻喉科项目。65%的项目至少实施了一项具体改变以符合工作时长限制。策略包括电子跟踪工作时长（35.7%）、采用“家中值班”（33.1%）以及雇佣额外的医疗保健专业人员（23.1%）。当被问及这些限制是否对患者护理产生负面影响时，61%的受访者表示没有，但令人惊讶的是，33%的受访者表示有。69%的教职员工认为这些限制实际上对住院医师培训产生了负面影响，而只有31%的住院医师持此观点（P<0.001）。39%的参与者认为在限制实施前住院医师的工作量过大。对于工作时长限制是否促进了住院医师教育、研究或考试成绩的提高，看法不一，但大多数人认为住院医师的心理健康有所改善（67%）。
耳鼻喉科住院医师培训项目通过重大的基础设施变革成功限制了住院医师的工作时长。令人担忧的是，大多数接受调查的住院医师似乎支持ACGME的限制，而大多数项目主任和教职员工则持反对态度。需要进一步研究以确定有限的工作时长会增强还是阻碍住院医师培训经历。
