Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
J Surg Res. 2010 Jul;162(1):33-6. doi: 10.1016/j.jss.2009.12.003. Epub 2009 Dec 30.
On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) required restriction of resident duty hours. Surgical programs were concerned about an expected decrease in operative experience. In our previous study, resident case coverage remained constant with the institution of the restricted duty hours. Several years later, we hypothesized that the level of resident coverage would be less appropriate.
A retrospective study was performed of elective cases scheduled for an academic general surgery practice over three time periods: 1 y prior to institution of restricted duty hours; 1 y later; 3 y later. Data collected included procedure performed, number of attending surgeons and residents present, and resident level. Resident level was defined as appropriate if it matched or exceeded the complexity of the procedure.
From July 2002 to June 2003, 890 records of 1278 scheduled cases were available for review. From July 2004 to June 2005, 961 records of 1182 cases were available. From July 2006 to June 2007, 1029 of 1171 records were available. Case coverage was the same or better in the latest time period overall and for each resident level. An appropriate level resident was available for senior level cases similarly during all periods. During the last period, junior and intermediate level cases were more often covered by a resident at the appropriate level of training.
The restricted duty hours have not negatively affected resident case coverage. The level of resident available for operative cases has remained constant for senior level cases. Junior and intermediate level cases were more often covered by an appropriate level resident.
2003 年 7 月 1 日，研究生医学教育认证委员会（ACGME）要求限制住院医师工作时间。外科项目担心手术经验预期会减少。在我们之前的研究中，随着限制工作时间制度的实施，住院医师的病例覆盖率保持不变。几年后，我们假设住院医师的覆盖率水平将不再合适。
对一个学术普外科实践中的择期病例进行了回顾性研究，时间跨度为三个时间段：限制工作时间制度实施前 1 年；实施后 1 年；实施后 3 年。收集的数据包括手术类型、手术主刀医生和住院医师的数量以及住院医师的级别。如果住院医师的级别与手术的复杂程度相匹配或超过手术的复杂程度，则定义为适当的级别。
2002 年 7 月至 2003 年 6 月，共有 1278 例计划手术的 890 份记录可用于审查。2004 年 7 月至 2005 年 6 月，有 1182 例计划手术的 961 份记录可用于审查。2006 年 7 月至 2007 年 6 月，有 1171 例计划手术的 1029 份记录可用于审查。在最新的时间段内，总体上和每个住院医师级别，病例覆盖情况相同或更好。在所有时期，高级别病例都有适当级别的住院医师可供使用。在最后一个时期，初级和中级别的病例更经常由具有适当培训水平的住院医师覆盖。
限制工作时间并未对住院医师的病例覆盖率产生负面影响。高级别手术病例的住院医师可用数量保持不变。初级和中级别的病例更经常由适当级别的住院医师覆盖。
