Miulli Dan E, Valcore Jennine C
Graduate Medical Education Office, Division of Neurosurgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324-1801, USA.
J Am Osteopath Assoc. 2010 Jul;110(7):385-95.
Current limitations on residency duty hours came about after the death of a patient in 1984 in a New York City hospital. This tragedy served as the catalyst for a new public awareness and subsequent change in philosophy regarding resident duty hours, fatigue factors, and risks to patients from the long and tedious shifts of residency. However, it has proven difficult to limit resident physician duty hours.
To analyze the impact of resident duty hour limitation (RDHL) implementation on residents, faculty, and patients.
The authors conducted a survey of faculty and resident attitudes and experiences regarding RDHLs in the graduate medical education department at Arrowhead Regional Medical Center (ARMC) in Colton, California. They also conducted a review of the literature on faculty and resident attitudes and experiences before and after implementation of RDHLs.
Of 60 surveys sent to ARMC faculty members in 2009, 12 (20.0%) were returned. Of 140 surveys sent to ARMC residents, 96 (68.6%) were returned. The survey results and literature review indicated that most faculty physicians initially believed that decreasing resident duty hours would limit the time available to residents for educational experiences and participation in treatment procedures, operations, and consultations. In addition, faculty initially believed that fewer training hours would diminish the quality of residents' educational experiences. Residents also expected negative outcomes from RDHLs. However, statistical data on actual outcomes revealed that residency programs are not adversely affected by limiting resident work hours to 80 hours per week. Furthermore, benefits of RDHLs appear to include improved patient care and well-rounded and psychologically balanced residents.
A survey and literature review revealed a number of benefits of RDHLs. It is unclear, however, whether additional limitations of resident work hours are necessary or could accommodate the growing amount of information and skills that are required to become a competent physician.
当前对住院医师值班时长的限制始于1984年纽约市一家医院一名患者的死亡。这场悲剧成为公众新的关注焦点，并促使人们在住院医师值班时长、疲劳因素以及长时间枯燥轮班对患者造成的风险等理念上发生了改变。然而，事实证明，限制住院医师值班时长并非易事。
分析实施住院医师值班时长限制（RDHL）对住院医师、带教教师和患者的影响。
作者对加利福尼亚州科尔顿市箭头区域医疗中心（ARMC）毕业后医学教育部门的带教教师和住院医师就RDHL的态度和经历进行了调查。他们还对实施RDHL前后关于带教教师和住院医师态度及经历的文献进行了综述。
2009年向ARMC的带教教师发放了60份调查问卷，回收了12份（20.0%）。向ARMC住院医师发放了140份调查问卷，回收了96份（68.6%）。调查结果和文献综述表明，大多数带教医师最初认为减少住院医师值班时长会限制住院医师用于教育经历以及参与治疗程序、手术和会诊的时间。此外，带教教师最初认为培训时长减少会降低住院医师教育经历的质量。住院医师也预计RDHL会带来负面结果。然而，实际结果的统计数据显示，将住院医师工作时长限制在每周80小时并不会对住院医师培训项目产生不利影响。此外，RDHL的益处似乎包括改善患者护理以及培养全面发展且心理平衡的住院医师。
一项调查和文献综述揭示了RDHL的诸多益处。然而，尚不清楚是否有必要进一步限制住院医师工作时长，或者这些限制能否适应成为一名合格医生所需的日益增长的信息量和技能要求。
