模糊地带的职业素养：一项关于外科住院医师轮班交接动态的多中心混合方法研究
Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies.
作者信息
Coverdill James E, Alseidi Adnan, Borgstrom David C, Dent Daniel L, Dumire Russell D, Fryer Jonathan, Hartranft Thomas H, Holsten Steven B, Nelson M Timothy, Shabahang Mohsen, Sherman Stanley, Termuhlen Paula M, Woods Randy J, Mellinger John D
机构信息
J.E. Coverdill is associate professor, Department of Sociology, University of Georgia, Athens, Georgia. A. Alseidi is associate director, General Surgery Residency Program, and director, HPB Fellowship, HPB and Endocrine Surgery, Virginia Mason Medical Center, Seattle, Washington. D.C. Borgstrom is associate professor, Department of Surgery, West Virginia University, Morgantown, West Virginia. D.L. Dent is professor of surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. R.D. Dumire is general surgery residency program director and medical director of trauma services, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania. J. Fryer is professor of surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. T.H. Hartranft is clinical professor of surgery, Ohio University, and general surgery residency program director, Mount Carmel Health System, Columbus, Ohio. S.B. Holsten is associate professor and general surgery residency program director, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia. T. Nelson is chief of general surgery and executive physician, Health System Surgical Services, University of New Mexico, Albuquerque, New Mexico. M. Shabahang is director, Department of General Surgery, and general surgery residency program director, Geisinger Medical Center, Danville, Pennsylvania. S. Sherman is associate clinical professor and associate director, General Surgery Residency Program, Michigan State University / Grand Rapids Medical Education Partners, Wyoming, Michigan. P.M. Termuhlen is regional campus dean, University of Minnesota Medical School, Duluth, Minnesota. R.J. Woods is associate professor and general surgery residency program director, Wright State University Boonshoft School of Medicine, Dayton, Ohio. J.D. Mellinger is professor, chair of general surgery, and general surgery residency program director, Southern Illinois University School of Medicine, Springfield, Illinois.
出版信息
Acad Med. 2016 Nov;91(11 Association of American Medical Colleges Learn Serve Lead: Proceedings of the 55th Annual Research in Medical Education Sessions):S31-S36. doi: 10.1097/ACM.0000000000001358.
PURPOSE
Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism.
METHOD
Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews.
RESULTS
A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient.
CONCLUSIONS
Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.
目的
值班时长规定引发了关于职业精神的讨论。本研究探讨普通外科住院医师在日班结束时延迟下班的情况是否以及为何符合轮班工作、传统职业精神或新职业精神。
方法
在2014年和2015年对13个普通外科项目的分类住院医师进行问卷调查。回复率为76%（N = 291）。这18个项目聚焦于轮班结束时的行为以及延迟下班的频率和原因。后续访谈（N = 39）调查了延迟下班的动机。结果包括均值、百分比以及访谈中的代表性引述。
结果
少数人（33%）认为将工作交接给夜班团队是常规且可接受的，而绝大多数人（81%）认为住院医师以职业精神之名延长了工作时间。延迟下班很普遍：在典型的一周内，291名住院医师中只有2人未因13种原因中的任何一种而延迟下班。最常见的延迟原因是不想给其他住院医师留下甩工作的印象。在访谈中，住院医师表示强烈不愿意将工作交接给值班住院医师或夜班团队，原因包括夜间人员配备不足、对患者的责任、厌恶甩工作以及担心被视为效率低下。
结论
住院医师的行为受到需要关注和改革的组织与文化环境的影响。证据表明新职业精神发展受阻，轮班工作思维作用不大，传统职业精神在住院医师行为中的表现参差不齐。
Zotero 插件