Kohlbrenner Amanda, Dirks Rachel, Davis James, Wolfe Mary, Maser Christina
UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
Am J Surg. 2016 Jun;211(6):1164-8. doi: 10.1016/j.amjsurg.2015.07.018. Epub 2015 Oct 29.
Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education.
A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system.
Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%.
Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time.
成功的外科手术教育需要在学习机会与研究生医学教育认证委员会（ACGME）规定的值班时长要求之间取得平衡。我们设立了夜班制度，并假设实施该制度将减少违反值班时长规定的情况，同时保持高质量的教育。
建立了一个团队交替进行12小时轮班的系统，并在实施后的2个月、6个月和12个月通过电子调查进行评估。在夜班制度实施前1年和实施后2年，对住院医师违反值班时长规定的情况和住院医师的病例量进行了评估。
调查数据显示，认为住院医师在遵守值班时长限制方面存在问题的比例从44%降至12个月时的14%（P = .012）。第一年违规总数增加了26%，随后下降了62%，其中轮班时长违规下降了90%。住院医师参加教学活动的可及性得到了改善，每个学年的平均手术病例数增加了65%。
夜班制度是可行的，有助于满足值班时长要求。我们的项目在减少违规的同时增加了手术量和教学时间。
