Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Surg Educ. 2013 Nov-Dec;70(6):769-76. doi: 10.1016/j.jsurg.2013.06.018. Epub 2013 Sep 14.
Resident duty-hour regulatory changes in July 2011 led to dramatic modifications in the structure of many surgical training programs in the United States. These changes were hypothesized to have effects on the quality of life and education of residents, and the patient care they deliver. Our study aims to measure changes in these domains among junior and senior residents before and after implementation of the latest regulations.
Longitudinal cohort study comparing objective and subjective metrics of education, patient care, and quality of life among all surgical residents at one institution.
Tertiary academic medical center.
All residents in the Department of Surgery over 2 years (n = 97) were included. The included electronic survey had 30 and 36 responses in 2011 and 2012, respectively (overall 68% response rate).
Operative cases increased for residents at all postgraduate year levels. No significant differences in in-training examination scores were observed. Comparison of subjective data from the program evaluation and developed survey revealed a significant decrease in perception of resident clinical skill development (4.31/5 in 2011 to 4.15/5 in 2012, p = 0.02). Residents reported decreased quality of operative experiences (83% to 59%, p = 0.04), and less independence evaluating patient problems (90% to 61%, p < 0.01). Levels of burnout were high in the entire group, but decreased significantly over the study period (93% and 75% in 2011 and 2012, respectively, p = 0.05), with the largest difference seen in individuals with "high burnout" (43% and 11%, in 2011 and 2012, respectively, p < 0.01). Residents met criteria for "sleepiness" before and after the 16-hour rule implementation (68% and 67%, in 2011 and 2012, respectively, p = 0.92).
Following the July 2011 duty-hour changes, surgical residents report a negative effect on their education, with decreased clinical skill progression and perceptions of operative experience quality and patient care independence. Improvements in quality of life metrics, including burnout, were observed.
2011 年 7 月，住院医师工作时间监管规定发生变化，导致美国许多外科培训项目的结构发生了重大改变。这些变化据推测会对住院医师的生活质量、教育和所提供的患者治疗产生影响。我们的研究旨在衡量最新规定实施前后初级和高级住院医师在这些领域的变化。
在一家机构中，对所有外科住院医师进行比较教育、患者护理和生活质量的客观和主观指标的纵向队列研究。
三级学术医疗中心。
该机构所有超过 2 年住院医师的部门（n = 97）都包括在内。包含的电子调查在 2011 年和 2012 年分别有 30 项和 36 项回复（总体回复率为 68%）。
所有住院医师的手术例数都有所增加。在住院医师年度培训考试成绩方面没有观察到显著差异。从项目评估和开发的调查中得出的主观数据比较显示，住院医师临床技能发展的认知显著下降（2011 年为 4.31/5，2012 年为 4.15/5，p = 0.02）。住院医师报告手术体验质量下降（83%降至 59%，p = 0.04），独立评估患者问题的能力下降（90%降至 61%，p < 0.01）。整个组的倦怠水平都很高，但在研究期间显著下降（2011 年和 2012 年分别为 93%和 75%，p = 0.05），“高倦怠”个体的差异最大（2011 年和 2012 年分别为 43%和 11%，p < 0.01）。在实施 16 小时规则前后，住院医师符合“困倦”标准（2011 年和 2012 年分别为 68%和 67%，p = 0.92）。
自 2011 年 7 月工作时间变化以来，外科住院医师报告说，他们的教育受到负面影响，临床技能进展以及对手术体验质量和患者护理独立性的认知下降。生活质量指标的改善，包括倦怠，得到了观察。
