Sundberg Kristina, Frydén Hanna, Kihlström Lars, Nordquist Jonas
BMC Med Educ. 2014;14 Suppl 1(Suppl 1):S6. doi: 10.1186/1472-6920-14-S1-S6. Epub 2014 Dec 11.
The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this "the Swedish duty hour enigma." This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions?
A case study was conducted at Karolinska University Hospital, Stockholm--an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research.
The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility.
According to Swedish residents' conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice.
瑞典住院医师工作时长限制受瑞典和欧洲法律框架监管。瑞典的工作时长规定是世界上限制最严格的规定之一，每周平均工作时长上限为40小时。与此同时，在瑞典的背景下，住院医师工作时长限制的影响尚未得到讨论或研究。因此，对于瑞典住院医师工作时长的概念框架、其限制或结果知之甚少：我们将此称为“瑞典工作时长之谜”。这种情况引发了另一个问题：瑞典住院医师自身如何构建工作时长限制的概念框架？
在斯德哥尔摩的卡罗林斯卡大学医院进行了一项案例研究，该医院是一家城市研究型医院。对目前在6个专业接受培训的34名住院医师进行了半结构化访谈。实证数据分析依赖于理论命题，并使用模式匹配技术进行主题分析。访谈指南基于四个主要主题：工作时长限制对（1）患者护理、（2）住院医师教育、（3）住院医师福祉和（4）研究的感知影响。
住院医师并不认为工作时长是患者护理、住院医师教育、住院医师福祉和研究这四个背景领域成败的主要决定因素。相反，他们强调住院医师福祉和对灵活性的渴望。
根据瑞典住院医师关于工作时长的概念框架，值班时间长短并非住院医师培训质量的指标。相反，工作时长的灵活性、组织和安排被认为是对住院医师福祉、学习质量以及获得独立执业所需能力的机会影响最大的因素。
