ACGME 工时限制对教育影响的长期随访：一项前后测调查研究。

Long-term follow-up on the educational impact of ACGME duty hour limits: a pre-post survey study.

机构信息

Department of General Surgery, Lahey Clinic Medical Center, Burlington, MA, USA.

出版信息

Ann Surg. 2012 Dec;256(6):1108-12. doi: 10.1097/SLA.0b013e31825ffb33.

DOI:10.1097/SLA.0b013e31825ffb33

PMID:23069864

Abstract

OBJECTIVE

To evaluate the long-term impact of the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hour limits on residents' perception of education.

BACKGROUND

Eight years after the introduction of the ACGME duty hour limits, graduate medical education programs implemented a revised set of standards. Currently, limited data exist related to the long-term impact of the 2003 standards on resident education.

METHODS

A yearly survey from 2003 to 2009 was administered to orthopedic residents in a multi-institutional program, inquiring about several aspects of the resident's educational experience, work hours, amount of sleep, fatigue and its impact, and preparedness for practice.

RESULTS

A total of 216 responses (69%) were obtained from surveyed orthopedic residents between 2003 and 2009. There was no significant change in the average reported hours of sleep (34.6 hours per week in 2003 vs 33.7 hours per week between 2004 and 2009) despite a decrease in the mean reported number of work hours (74.5 hours in 2003 vs 66.2 hours in 2009; P = 0.046). However, a decrease in perceived fatigue and its negative impact on patient safety and quality of care was noted. The perceived sufficiency of direct clinical experience, the number of hours spent performing major procedures, and the overall satisfaction with education also decreased. Finally, the residents' sense of clinical preparedness diminished after the work hour limits were in place.

CONCLUSIONS

After the implementation of the 2003 duty hour limits, residents' perceptions of fatigue improved without any increase in the reported amount of sleep. In addition, decreased resident satisfaction with their education and a diminished sense of clinical preparedness were noted. Additional studies are needed to better understand the influence of work hours and fatigue on the outcomes of education, resident well-being, and patient care to guide the optimal design and delivery of graduate medical education.

摘要

目的

评估 2003 年毕业后医学教育认证委员会（ACGME）工时限制对住院医师教育认知的长期影响。

背景

在实施 ACGME 工时限制 8 年后，研究生医学教育项目实施了一套修订后的标准。目前，关于 2003 年标准对住院医师教育的长期影响的数据有限。

方法

在一项多机构项目中，每年对骨科住院医师进行一次调查，询问他们的教育经历、工作时间、睡眠时间、疲劳及其影响、实践准备等方面的情况。

结果

2003 年至 2009 年，共收到 216 名（69%）接受调查的骨科住院医师的回复。尽管报告的平均工作时间减少（2003 年为 74.5 小时，2004 年至 2009 年为 66.2 小时；P=0.046），但报告的平均睡眠时间（2003 年为 34.6 小时，2004 年至 2009 年为 33.7 小时）并无显著变化。然而，住院医师对疲劳的认知及其对患者安全和医疗质量的负面影响有所降低。直接临床经验的充足感、进行主要手术的时间以及对教育的总体满意度也有所下降。最后，在实行工时限制后，住院医师的临床准备感减弱。