Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JAMA Surg. 2013 May;148(5):448-55. doi: 10.1001/jamasurg.2013.1368.
To measure the implications of the new Accreditation Council for Graduate Medical Education duty hour regulations for education, well-being, and burnout.
Longitudinal study.
Eleven university-based general surgery residency programs from July 2011 to May 2012.
Two hundred thirteen surgical interns.
Perceptions of the impact of the new duty hours on various aspects of surgical training, including the 6 Accreditation Council for Graduate Medical Education core competencies, were measured on 3-point scales. Quality of life, burnout, balance between personal and professional life, and career satisfaction were measured using validated instruments.
Half of all interns felt that the duty hour changes have decreased the coordination of patient care (53%), their ability to achieve continuity with hospitalized patients (70%), and their time spent in the operating room (57%). Less than half (44%) of interns believed that the new standards have decreased resident fatigue. In longitudinal analysis, residents' beliefs had significantly changed in 2 categories: less likely to believe that practice-based learning and improvement had improved and more likely to report no change to resident fatigue (P < .01, χ2 tests). The majority (82%) of residents reported a neutral or good overall quality of life. Compared with the normal US population, 50 interns (32%) were 0.5 SD less than the mean on the 8-item Short Form Health Survey mental quality of life score. Approximately one-third of interns demonstrated weekly symptoms of emotional exhaustion (28%) or depersonalization (28%) or reported that their personal-professional balance was either "very poor" or "not great" (32%). Although many interns (67%) reported that they daily or weekly reflect on their satisfaction from being a surgeon, 1 in 7 considered giving up their career as a surgeon on at least a weekly basis.
The first cohort of surgical interns to train under the new regulations report decreased continuity with patients, coordination of patient care, and time spent in the operating room. Furthermore, suboptimal quality of life, burnout, and thoughts of giving up surgery were common, even under the new paradigm of reduced work hours.
衡量新的住院医师规范化培训评估委员会（Accreditation Council for Graduate Medical Education）工时规定对教育、幸福感和职业倦怠的影响。
纵向研究。
2011 年 7 月至 2012 年 5 月，11 所大学的普外科住院医师培训计划。
213 名外科住院医师。
采用 3 分制衡量新工时对各种外科培训方面的影响，包括 6 项住院医师规范化培训评估委员会核心能力。使用经过验证的工具测量生活质量、职业倦怠、个人生活与工作平衡以及职业满意度。
近一半的住院医师认为，工时变化减少了患者护理的协调性（53%）、与住院患者保持连续性的能力（70%）以及他们在手术室的时间（57%）。不到一半（44%）的住院医师认为新标准降低了住院医师的疲劳感。纵向分析显示，住院医师的信念在 2 个类别中发生了显著变化：认为实践学习和改进有所改善的可能性降低，而报告住院医师疲劳感无变化的可能性增加（P<.01，χ2 检验）。大多数（82%）住院医师报告生活质量总体处于中等或良好水平。与正常的美国人群相比，50 名住院医师（32%）在 8 项简短健康调查心理健康生活质量评分中低于平均值 0.5 个标准差。大约三分之一的住院医师每周出现情绪耗竭（28%）或去人格化（28%）的症状，或报告个人-职业平衡“非常差”或“不太好”（32%）。尽管许多住院医师（67%）报告每天或每周都会反思自己作为外科医生的满意度，但仍有 1/7 的人每周至少有一次考虑放弃外科医生的职业。
第一批接受新规定培训的外科住院医师报告说，他们与患者的连续性、患者护理的协调性以及在手术室的时间减少。此外，即使在新的减少工作时间模式下，生活质量不佳、职业倦怠和放弃手术的想法也很常见。
