Luciano Gina, Hambour Lydia, Luciano Paul, Holmboe Eric, Aulakh Sudeep, Fleming Simon, Rosenblum Michael
Baystate Health, Springfield, MA, USA.
Rocket Lab, Auckland, New Zealand.
J Gen Intern Med. 2020 Nov;35(11):3333-3337. doi: 10.1007/s11606-020-05894-z. Epub 2020 May 29.
Since 2011, aviation has revolutionized their approach to safety. The aviation industry has adopted a multi-faceted approach to improve safety through decreasing duty hour limits and implementing processes to mitigate fatigue-related errors as well as creating cultural shifts in responsibility for safety. These changes have been guided by data generated by quality-improvement methodology. In contrast, duty hour limits in graduate medical education have not yet seen dramatic data-driven reform. Key advancements in aviation fatigue mitigation and implications for residency education are explored in this article. Scientifically based processes to optimize duty hours, quality-improvement strategies to iteratively monitor and reform duty limits, systematic change focusing on a just culture, and financial disincentives and incentives as a catalyst for change are discussed.
自2011年以来，航空业彻底改变了其安全管理方法。航空业采取了多方面的措施来提高安全性，包括减少值班时间限制、实施减轻疲劳相关错误的流程以及营造安全责任文化转变。这些变革是由质量改进方法产生的数据所引导的。相比之下，研究生医学教育中的值班时间限制尚未经历显著的数据驱动型改革。本文探讨了航空业减轻疲劳的关键进展及其对住院医师教育的影响。讨论了基于科学的优化值班时间流程、迭代监测和改革值班限制的质量改进策略、关注公正文化的系统性变革以及作为变革催化剂的经济激励和抑制措施。
