Riverside Methodist Hospital, Columbus, Ohio 43214, USA.
J Surg Educ. 2010 Sep-Oct;67(5):283-9. doi: 10.1016/j.jsurg.2010.07.012.
The objective of this statistical analysis was to test the hypothesis that implementation of the 80-hour workweek restrictions for General Surgery residents at Riverside Methodist Hospital after July 2003 decreased their operative experience relative to surgical residents trained at Riverside before these changes.
DESIGN, SETTING, PARTICIPANTS: Data were collected from the Accreditation Council for Graduate Medical Education national database and from Riverside Methodist Hospital's General Surgery Residency records for a sampling of academic years before and after the duty-hour changes in surgical education (July 1, 2003). Current procedural terminology (CPT) surgical procedure codes logged by postgraduate year (PGY) 5 General Surgery residents 15 years before and 5 years after implementation of the 80-hour workweek were compared. The outcome variables "total major cases" and "Chief cases" were compared between 2 study groups defined by the time intervals exclusively before July 2003 ("pre") and inclusively after July 2003 ("post"). Hospital general surgical case volume for the study intervals was also tallied. Statistical analyses included 1- and 2-sided t-tests, nonparametric tests, and t-tests on a 3-parameter logarithmic transformation of the data.
Despite an upward trend in total general surgery cases (slope = 25/year, p = 0.005), there was a statistically significant decrease in the operative experience for categorical surgical residents following the 80-hour workweek restrictions. The mean (SD) number of major cases performed by "pre"-restriction residents during their training significantly exceeded that of their "post" cohorts (1395 [326] vs 953 [134], p < 0.001). The training for PGY 5 residents was similarly influenced (345 [81] vs 237 [55], p < .0001).
Despite an increase in the total number of major operative cases available, the volume of cases performed by residents has decreased after implementation of the Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions. Our data suggest that the impact of the 80-hour workweek has had a detrimental effect on the conventional resident training experience.
本统计分析的目的是检验假设，即在 2003 年 7 月之后，河滨卫理公会医院的普通外科住院医师实施 80 小时工作周限制，相对于在这些变化之前在河滨接受培训的外科住院医师，他们的手术经验会减少。
设计、地点、参与者：数据来自研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education）的国家数据库以及河滨卫理公会医院普通外科住院医师记录，这些数据取自外科教育（2003 年 7 月 1 日）前后的几个学年。比较了 5 年级普通外科住院医师在实施 80 小时工作制之前 15 年和之后 5 年的当前程序术语（Current Procedural Terminology，CPT）手术程序代码记录。通过在 2003 年 7 月之前的时间间隔（“前”）和之后的时间间隔（“后”）之间定义的两个研究组，比较了“总主要病例”和“首席病例”这两个结果变量。还对研究期间医院普外科的一般手术病例量进行了统计。统计分析包括 1 侧和 2 侧 t 检验、非参数检验以及对数据的 3 参数对数转换的 t 检验。
尽管普外科的总病例数呈上升趋势（斜率=25/年，p=0.005），但在 80 小时工作制限制之后，分类外科住院医师的手术经验却出现了统计学上的显著下降。在培训期间，“前”限制住院医师完成的主要病例数明显多于“后”组（1395[326]比 953[134]，p<0.001）。PGY5 住院医师的培训也受到类似的影响（345[81]比 237[55]，p<.0001）。
尽管主要手术病例总数有所增加，但在实施研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education，ACGME）工时限制后，住院医师完成的病例数量有所减少。我们的数据表明，80 小时工作制的实施对传统住院医师培训经验产生了不利影响。
