Kocolas Irene, Day Kristen, King Marta, Stevenson Adam, Sheng Xiaoming, Hobson Wendy, Bruse Jaime, Bale James
Department of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Department of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Acad Pediatr. 2017 Mar;17(2):149-152. doi: 10.1016/j.acap.2016.10.005.
The effects of 2011 Accreditation Council on Graduate Medical Education (ACGME) duty hour standards on intern work hours, patient load, conference attendance, and sleep have not been fully determined. We prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in a 2011 ACGME duty hour-compliant shift schedule with a 2003 ACGME duty hour-compliant call schedule at a single pediatric residency program.
Interns were assigned to shift or call schedules during 4 alternate months in the winter of 2010-2011. Work hours, patient numbers, conference attendance, sleep duration, pattern, and quality were tracked.
Interns worked significantly fewer hours per week on day (73.2 hours) or night (71.6 hours) shifts than during q4 call (79.6 hours; P < .01). During high census months, shift schedule interns cared for significantly more patients/day (8.1/day shift vs 6.2/call; P < .001) and attended significantly fewer conferences than call schedule interns. Night shift interns slept more hours per 24-hour period than call schedule interns (7.2 ± 0.5 vs 6.3 ± 0.9 hours; P < .05) and had more consistent sleep patterns.
A shift schedule resulted in reduced intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning remained robust with unchanged or increased intern patient numbers.
2011年研究生医学教育认证委员会（ACGME）的值班时间标准对实习医生的工作时长、患者接待量、参加会议情况及睡眠的影响尚未完全明确。我们前瞻性地比较了在单一儿科住院医师培训项目中，2011年符合ACGME值班时间标准的轮班安排与2003年符合ACGME值班时间标准的呼叫安排下，实习医生的工作时长、患者数量、参加会议情况、睡眠时间、模式及质量。
在2010 - 2011年冬季的4个交替月份中，将实习医生分配到轮班或呼叫安排中。对工作时长、患者数量、参加会议情况、睡眠时间、模式及质量进行跟踪。
与季度呼叫期间（79.6小时）相比，实习医生在白班（73.2小时）或夜班（71.6小时）的每周工作时长显著减少（P <.01）。在高普查月份，轮班安排的实习医生每天照顾的患者明显更多（白班8.1名/天 vs 呼叫安排6.2名/天；P <.001），且参加会议的次数明显少于呼叫安排的实习医生。夜班实习医生每24小时的睡眠时间比呼叫安排的实习医生更长（7.2 ± 0.5小时 vs 6.3 ± 0.9小时；P <.05），睡眠模式更稳定。
轮班安排减少了实习医生的工作时长，改善了睡眠时间和模式。尽管在高普查月份实习医生参加理论会议的次数显著减少，但随着实习医生接待患者数量不变或增加，实践学习的机会依然充足。
