Department of Plastic Surgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA.
JAMA Surg. 2013 May;148(5):427-33. doi: 10.1001/jamasurg.2013.169.
In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.
To examine surgical residents' views of the 2011 ACGME Common Program requirements after implementation in July 2011.
A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.
ACGME-accredited teaching hospitals in the United States and US territories.
The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.
Residents' perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.
A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).
A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions-improved education, patient care, and quality of life-have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.
2010 年，研究生医学教育认证委员会（ACGME）提出增加对住院医师工作时间和监督的规定。2011 年 7 月生效的新的共同计划要求极大地改变了传统的 24 小时内部值班时间表。外科住院医师更有可能受到这些工作时间限制的影响。
在 2011 年 ACGME 共同计划要求于 7 月实施后，研究外科住院医师对这些要求的看法。
在 2011 年 ACGME 规定实施 6 个月后，向 123 个参与机构的 1013 名参与研究的住院医师发放了一份 20 个问题的电子调查问卷。
美国和美国领土上的 ACGME 认证教学医院。
总样本为来自 ACGME 认证机构的普通外科和外科专业的 1013 名自愿参与的住院医师。
住院医师对实施 2011 年 ACGME 工作时间规定后教育、患者护理和生活质量的变化的看法，以及他们对这些规定的遵守情况。
从 6202 名调查对象中具有代表性的样本中确定了一组来自普通外科或外科亚专业培训的 1013 名住院医师。大多数外科住院医师表示，教育（55.1%）、为高级角色做准备（68.4%）和工作时间表（50.7%）在实施 2011 年规定后变得更糟。他们报告监督（80.8%）、患者护理安全（53.4%）或休息时间（57.8%）没有变化。尽管实习医生的生活质量被认为更好（61.9%），但大多数住院医师认为高级住院医师的生活质量更差（54.4%）。大多数住院医师报告交接班增加（78.2%）和初级责任向高级住院医师转移（68.7%）。最后，许多住院医师报告不遵守规定（67.6%）和伪造工作时间（62.1%）。
大多数外科住院医师不赞成 2011 年 ACGME 共同计划要求（65.9%）。增加工作时间限制的预期好处，即改善教育、患者护理和生活质量，在外科培训中显然没有得到体现。在 2011 年 ACGME 规定下，住院医师，尤其是在外科领域的住院医师，可能很难学习和照顾患者。
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