Sneider Erica B, Larkin Anne C, Shah Shimul A
Department of Surgery, School of Medicine, University of Massachusetts, Worcester, Massachusetts 01655, USA.
J Surg Educ. 2009 May-Jun;66(3):140-5. doi: 10.1016/j.jsurg.2008.10.005.
To evaluate the effect of the 80-hour workweek restrictions on resident education within surgical programs in the New England area.
Web-based survey.
All Accreditation Council for Graduate Medical Education (ACGME) accredited surgical residency programs in New England (n = 20).
Program directors/coordinators in each surgical residency program in New England.
First, American Board of Surgery In-Training Examination (ABSITE) scores and the passing rate of the ABS certifying examination were recorded for the years 2001, 2002, 2005, and 2006. Second, the changes in the curriculum of surgical education were documented as perceived by program coordinators and directors.
In all, 85% (17/20) of surgical programs in New England responded to the survey. The programs began to implement the 80-hour workweek from 2002 to 2004. An equal distribution of community (n = 8) and university programs (n = 9) was sampled. Prior to the initiation of the 80-hour workweek, residency programs emphasized weekly didactic sessions given by attending physicians (88%), mock orals (88%), and conventional journal club (76%). After the 80-hour workweek was implemented, the education curriculum most often consisted of didactic sessions by attending (100%), mock orals (88%), and simulation laboratories (75%). No difference was observed in ABSITE scores and first-time pass rates of the ABS examination before or after the introduction of the 80-hour workweek (20% response). Only 25% of programs felt that surgical education was improved after the implementation of the 80-hour workweek, whereas 31% felt education was worse. Overall, 44% of respondents believed that there was no difference in surgical education.
Despite the positive effects the 80-hour workweek has had on resident quality of life and patient care, it does not seem that either significant improvements or detrimental effects have occurred on surgical education within residency programs in New England.
评估每周80小时工作时长限制对新英格兰地区外科住院医师培训项目中住院医师教育的影响。
基于网络的调查。
新英格兰地区所有经研究生医学教育认证委员会（ACGME）认证的外科住院医师培训项目（n = 20）。
新英格兰地区每个外科住院医师培训项目的项目主任/协调员。
第一，记录2001年、2002年、2005年和2006年美国外科委员会住院医师培训考试（ABSITE）成绩以及ABS认证考试的通过率。第二，记录项目协调员和主任所感知到的外科教育课程的变化。
新英格兰地区85%（17/20）的外科项目回复了调查。这些项目于2002年至2004年开始实施每周80小时的工作时长。抽样的社区项目（n = 8）和大学项目（n = 9）分布均衡。在每周80小时工作时长开始之前，住院医师培训项目强调由主治医师进行的每周理论课程（88%）、模拟口试（88%）和传统的期刊讨论会（76%）。在实施每周80小时工作时长之后，教育课程最常包括由主治医师进行的理论课程（100%）、模拟口试（88%）和模拟实验室（75%）。在引入每周80小时工作时长之前或之后，ABSITE成绩和ABS考试的首次通过率没有差异（20%的回复率）。只有25%的项目认为在实施每周80小时工作时长之后外科教育得到了改善，而31%的项目认为教育变差了。总体而言，44%的受访者认为外科教育没有差异。
尽管每周80小时工作时长对住院医师的生活质量和患者护理产生了积极影响，但在新英格兰地区的住院医师培训项目中，外科教育似乎既没有显著改善，也没有受到不利影响。
