From the Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Missouri.
Obstet Gynecol. 2010 Jun;115(6):1166-1171. doi: 10.1097/AOG.0b013e3181de8cdb.
To evaluate resident experience in obstetric and gynecologic procedures after implementation of resident work-hour restrictions.
Median resident experience in core obstetric and gynecologic procedures in the role of "surgeon" for the 3-year period before the implementation of work-hour restrictions were compared with data from a similar 3-year period starting 4 years after the work-hour rules were in effect. Comparisons to national practice changes occurring over the same time period were made with national data.
Resident experience in core obstetric procedures has changed in parallel with those occurring nationally, but with little overall effect on total experience (3-year average of median total cases, 513 compared with 510) with a decrease in operative vaginal deliveries (42 compared with 26 cases) and an increase in cesarean deliveries (166 compared with 221 cases). Resident experience with abdominal hysterectomy declined (83.7 compared with 75.4 cases), while experience with vaginal hysterectomy remained steady (31.3 compared with 34.6 cases). In contrast, there was an increase in experience with laparotomy (41.7 compared with 54.6 cases), laparoscopy (56.7 compared with 94 cases), and hysteroscopy (39.7 compared with 62.7 cases). Comparisons to national practice changes occurring over the same time period show similar patterns.
The imposition of work-hour restrictions has not had material negative effects on resident technical experience.
III.
评估住院医师在实施工作时间限制后进行妇产科手术的经验。
比较实施工作时间限制前 3 年期间作为“外科医生”的核心妇产科手术中位住院医师经验，以及工作时间规则实施 4 年后类似的 3 年期间的数据。与同期全国范围内发生的实践变化进行比较，并与全国数据进行比较。
住院医师在核心产科手术中的经验与全国范围内的经验变化同步，但对总经验的总体影响较小（3 年平均中位数总病例数为 513 例，而 510 例），其中阴道分娩（42 例与 26 例）减少，剖宫产（166 例与 221 例）增加。腹式子宫切除术的经验减少（83.7 例与 75.4 例），而阴道子宫切除术的经验保持稳定（31.3 例与 34.6 例）。相比之下，剖腹术（41.7 例与 54.6 例）、腹腔镜检查（56.7 例与 94 例）和宫腔镜检查（39.7 例与 62.7 例）的经验有所增加。与同期全国范围内发生的实践变化进行比较显示出相似的模式。
实施工作时间限制对住院医师的技术经验没有产生实质性的负面影响。
III 级。
