Department of Orthopaedics, Vanderbilt University, Nashville, TN 37232, USA.
J Bone Joint Surg Am. 2011 Dec 7;93(23):e1421-9. doi: 10.2106/JBJS.K.00700.
The Accreditation Council for Graduate Medical Education (ACGME) established national guidelines for resident duty hours in July 2003. Following an Institute of Medicine report in December 2008, the ACGME recommended further restrictions on resident duty hours that went into effect in July 2011. We conducted a national survey to assess the opinions of orthopaedic residents and of directors of residency and fellowship programs in the U.S. regarding the 2003 and 2011 ACGME resident duty-hour regulations and the effects of these regulations on resident education and patient care.
A fifteen-item questionnaire was electronically distributed by the Candidate, Resident, and Fellow Committee of the American Academy of Orthopaedic Surgeons (AAOS) to all U.S. orthopaedic residents (n = 3860) and directors of residency programs (n = 184) and fellowship programs (n = 496) between January and April 2011. Thirty-four percent (1314) of the residents and 27% (185) of the program directors completed the questionnaire. Statistical analyses were performed to detect differences between the responses of residents and program directors and between the responses of junior and senior residents.
The responses of orthopaedic residents and program directors differed significantly (p < 0.001) for fourteen of the fifteen survey items. The responses of residents and program directors were divergent for questions regarding the 2003 rules. Overall, 71% of residents thought that the eighty-hour work week was appropriate, whereas only 38% of program directors agreed (p < 0.001). Most program directors (70%) did not think that the 2003 duty-hour rules had improved patient care, whereas only 24% of residents responded in the same way (p < 0.001). The responses of residents and program directors to questions regarding the 2011 duty-hour rules were generally compatible, but the degree to which they perceived the issues was different. Only 18% of residents and 19% of program directors thought that the suggested strategic five-hour evening rest period implemented in July 2011 for on-call residents was appropriate (p > 0.05), and both groups (84% of residents and 74% of program directors) also disagreed with the limitation of intern shifts to sixteen hours (p < 0.001). Seventy percent of residents and 79% of program directors thought that the new duty-hour regulations would result in an increased number of handoffs that would be detrimental to patient care (p < 0.001). The mean responses of junior residents and senior residents differed for eight of the fifteen survey items (p < 0.001), with the responses of senior residents more closely resembling those of program directors on six of these eight questions. The mean responses and percentiles for the survey items did not differ significantly between residency directors and fellowship directors (p > 0.05).
This national survey indicated significant differences between the opinions of orthopaedic residents and program (residency and fellowship) directors regarding the 2003 ACGME resident duty-hour regulations and the effects of these regulations on resident education and patient care. However, both residents and program directors agreed that the further reductions in duty hours in the 2011 rules may be detrimental to resident education and patient care.
美国毕业后医学教育认证委员会（ACGME）于 2003 年 7 月制定了住院医师工作时间的国家指南。在 2008 年 12 月美国医学研究所的一份报告之后，ACGME 建议对住院医师工作时间进一步限制，并于 2011 年 7 月生效。我们进行了一项全国性调查，以评估美国骨科住院医师和住院医师培训计划主任对 2003 年和 2011 年 ACGME 住院医师工作时间法规的意见，以及这些法规对住院医师教育和患者护理的影响。
美国骨科医师学会（AAOS）的候选人、住院医师和研究员委员会于 2011 年 1 月至 4 月期间通过电子邮件向所有美国骨科住院医师（n=3860）和住院医师培训计划主任（n=184）和研究员培训计划主任（n=496）分发了一份包含 15 个项目的问卷。34%（1314）的住院医师和 27%（185）的项目主任完成了问卷。为了检测住院医师和项目主任之间的回答以及初级和高级住院医师之间的回答的差异，我们进行了统计分析。
骨科住院医师和项目主任对 15 个调查项目中的 14 个回答存在显著差异（p < 0.001）。住院医师和项目主任对 2003 年规则的问题回答存在分歧。总体而言，71%的住院医师认为每周 80 小时的工作时间是合适的，而只有 38%的项目主任同意（p < 0.001）。大多数项目主任（70%）认为 2003 年的工作时间规则并没有改善患者护理，而只有 24%的住院医师持相同看法（p < 0.001）。住院医师和项目主任对 2011 年工作时间规则的回答总体上是一致的，但他们对这些问题的看法有所不同。只有 18%的住院医师和 19%的项目主任认为，为值班住院医师实施的建议性 5 小时晚间休息时间（2011 年 7 月开始实施）是合适的（p > 0.05），而且这两个群体（84%的住院医师和 74%的项目主任）也不同意限制实习医师轮班时间为 16 小时（p < 0.001）。70%的住院医师和 79%的项目主任认为，新的工作时间法规将导致更多的交接，这将对患者护理不利（p < 0.001）。15 个调查项目中有 8 个项目的初级住院医师和高级住院医师的平均回答存在差异（p < 0.001），其中高级住院医师在这 8 个问题中的 6 个问题上的回答更接近项目主任的回答。项目主任和研究员培训计划主任的平均回答和百分位数在调查项目中没有显著差异（p > 0.05）。
这项全国性调查表明，骨科住院医师和项目（住院医师培训和研究员培训）主任对 2003 年 ACGME 住院医师工作时间法规以及这些法规对住院医师教育和患者护理的影响存在显著差异。然而，住院医师和项目主任都认为 2011 年规则中进一步减少工作时间可能对住院医师教育和患者护理不利。
