Shin Susanna, Britt Rebecca, Britt L D
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
J Am Coll Surg. 2008 May;206(5):798-800; discussion 801-3. doi: 10.1016/j.jamcollsurg.2007.12.028. Epub 2008 Mar 24.
On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees.
A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident.
From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall.
Restricted duty hours have not affected resident case coverage.
2003年7月1日起，住院医师培训项目必须按照毕业后医学教育认证委员会的要求实行有限的工作时间。外科住院医师和教员都表达了一个主要担忧，即预计这会导致手术经验减少。我们假设实行有限的工作时间会减少住院医师培训学员的病例覆盖量。
对2003年7月1日前后一年中一个普通外科科室安排的手术和内镜病例进行了回顾性研究。收集的数据包括所实施的手术、在场主治医生数量、是否有住院医师在场以及住院医师级别。
2002年7月至2003年6月，安排了1278例病例；有890份记录可用。2004年7月至2005年6月，安排了1182例病例；有960份记录可用。在实行有限工作时间之前，初级（PGY1和PGY2）病例中有24.6%、中级（PGY3）病例中有21.7%、高级（PGY4和PGY5）病例中有6.2%没有住院医师覆盖。实行有限工作时间后，初级病例中有27.3%、中级病例中有15.9%、高级病例中有8.1%没有住院医师覆盖。总体而言，实行有限工作时间之前和之后，分别有20.8%（890例中的185例）和20.4%（960例中的196例）的病例没有住院医师覆盖。各分类或总体病例覆盖量的差异无统计学意义。
有限工作时间并未影响住院医师的病例覆盖量。
