Division of Surgical Education, Department of Surgery, Hospital of the University of Pennsylvania, Arlington, Massachusetts 02474, USA.
J Surg Educ. 2009 Nov-Dec;66(6):357-60. doi: 10.1016/j.jsurg.2009.07.005.
PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions have prompted many surgical training programs to adopt a night-float resident coverage system (NF). Dissatisfaction with NF prompted us to transition to a rotating junior resident call model (Q4) with 24-hour call shifts at the outset of the 2007-2008 academic year. We performed a prospective study to determine the influence of this transition on resident education, morale, and quality of life, as well as on ACGME work rule compliance and American Board of Surgery In-Training Examination (ABSITE) scores. METHODS: Residents were surveyed after 1 year of NF and again 1 year after the introduction of Q4. Responses to a series of statements about the influence of the call model (NF or Q4) on educational opportunities and morale were solicited. The survey used a 5-point Likert response scale (1 = complete disagreement to 5 = complete agreement). Median values of participant responses were calculated and compared using the Wilcoxon rank-sum test. Compliance with ACGME work rules, ABSITE scores, and operative case logs from the 2006-2007 and 2007-2008 academic years were also compared. RESULTS: Residents were significantly more enthusiastic about Q4 compared with NF, particularly when asked about the influence these systems had on morale (median response = 4.0 [Q4] compared with 2.0 [NF]; p = 0.001) and engagement of residents by the teaching faculty (median response = 4.0 [Q4] compared with 1.0 [NF]; p = 0.001). Case logs revealed a similar operative experience for first-year residents irrespective of the call schedule (p = 0.51). Excellent compliance with ACGME work rules was maintained as reflected by the percentage of monthly 80-hour violations per resident months worked (3% [Q4] compared with 0.7% [NF]). No difference was observed in the ABSITE scores of first-year residents (a mean percentile point increase of 1 was found after the introduction of Q4). CONCLUSIONS: Educational opportunities, compliance with ACGME work rules, and ABSITE scores can be preserved despite a transition from NF to Q4. Residents greatly prefer a rotating call schedule.
目的：住院医师规范化培训（ACGME）的工时限制促使许多外科培训项目采用了夜间浮动居民覆盖系统（NF）。对 NF 的不满促使我们在 2007-2008 学年开始时过渡到一种轮转初级住院医师值班模式（Q4），并实行 24 小时值班。我们进行了一项前瞻性研究，以确定这种转变对住院医师教育、士气和生活质量的影响，以及对 ACGME 工作规则的遵守情况和美国外科学委员会住院医师培训考试（ABSITE）成绩的影响。
方法：在 NF 实施 1 年后和 Q4 实施 1 年后，对住院医师进行了调查。征求了关于值班模式（NF 或 Q4）对教育机会和士气影响的一系列陈述的答复。该调查使用了 5 分李克特反应量表（1=完全不同意，5=完全同意）。使用 Wilcoxon 秩和检验计算并比较参与者反应的中位数。还比较了 2006-2007 学年和 2007-2008 学年的 ACGME 工作规则遵守情况、ABSITE 成绩和手术病例记录。
结果：与 NF 相比，住院医师对 Q4 明显更感兴趣，特别是当被问及这些系统对士气（中位数反应=4.0[Q4]与 2.0[NF]；p=0.001）和教员对住院医师的参与（中位数反应=4.0[Q4]与 1.0[NF]；p=0.001）的影响时。病例记录显示，无论值班安排如何，第一年住院医师的手术经验都相似（p=0.51）。住院医师工作月中每月 80 小时违规百分比（Q4 为 3%，NF 为 0.7%）反映出对 ACGME 工作规则的出色遵守。第一年住院医师的 ABSITE 成绩没有差异（Q4 实施后平均百分位点增加 1）。
结论：尽管从 NF 过渡到 Q4，但教育机会、ACGME 工作规则的遵守情况和 ABSITE 成绩都可以得到保持。住院医师非常喜欢轮转值班制度。
J Surg Educ. 2008
J Am Coll Surg. 2007-9
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