University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Surg Educ. 2021 Nov-Dec;78(6):e210-e217. doi: 10.1016/j.jsurg.2021.06.024. Epub 2021 Jul 19.
The Accreditation Council for Graduate Medical Education specifies strict requirements for clinical work hours during residency training, with serious consequences for violations. Self-reporting of work hours by trainees can be inaccurate due to recall bias, giving program directors limited data to influence change. We aimed to assess the impact of a smart-phone based geofencing application on submission rates for work hours and reported violations in a general surgery residency program at a university-based medical center. We also examined resident perceptions surrounding implementation and use of the application.
We compared clinical work hours submitted and violations reported during the pilot period (October-November 2019) with the months prior to the launch of the application (July-August 2019). PGY1 and PGY2 residents were eligible to use the application during and after this pilot period. Semi-structured interviews were used to assess resident perceptions. A retrospective review was conducted to compare reporting during the same time period from the prior academic year (2018-2019) for historical reference. Paired t-tests were used to analyze the data.
Twenty-six residents (15 PGY1, 11 PGY2) were eligible for the intervention and 23 residents (88%) used the application. The mean number of violations reported decreased significantly during the pilot period compared with the months prior to the intervention (4.5 vs. 11, p = 0.04). The total rate of submissions was not significantly different after the intervention (85% vs. 82%, p = 0.42). The PGY1 mean submission rate decreased during the pilot period (91%-75%, p = 0.21) while the PGY2 submission rate increased (77%-91%, p = 0.07). Compared with historical data, there was an increase in overall total submission rates between academic years 2018/2019 and 2019/2020 (74% vs. 79%, p = 0.047) and an associated decrease in the mean number of monthly violations (14 vs. 6.25, p = 0.004). Thirteen (50%) residents (8 PGY1, 5 PGY2) volunteered for semi-structured interviews. Most participants found the application useful for recording and reporting clinical work hours. They noted an ease in the administrative burden as well as more accurate reporting associated with automated logging. Use of the application was not perceived to limit engagement with patient care; however, there were privacy concerns and some technical barriers were identified. The messaging regarding the application's use was identified as critical for implementation.
The "real-time" data provided by a geofencing application in our program helped to reduce the number of work-hour violations reported and did not diminish resident engagement with patient care. Decreasing the administrative burden of recording work hours coupled with improving transparency and accuracy of submissions may be important mechanisms.
研究生医学教育认证委员会对住院医师培训期间的临床工作时间制定了严格的要求，违反规定将产生严重后果。由于回忆偏差，学员对工作时间的自我报告可能不准确，这使得项目主管能够影响改变的可用数据有限。我们旨在评估基于智能手机的地理围栏应用程序对大学医学中心普外科住院医师培训项目中工作时间提交和报告违规情况的影响。我们还研究了住院医师对该应用程序实施和使用的看法。
我们比较了试点期间（2019 年 10 月至 11 月）和应用程序推出前的月份（2019 年 7 月至 8 月）提交的临床工作时间和报告的违规情况。PGY1 和 PGY2 住院医师有资格在试点期间和之后使用该应用程序。使用半结构化访谈评估住院医师的看法。回顾性分析比较了前一学年（2018-2019 年）同期的报告情况，以作历史参考。使用配对 t 检验分析数据。
共有 26 名（15 名 PGY1，11 名 PGY2）住院医师符合干预条件，有 23 名（88%）住院医师使用了该应用程序。与干预前的月份相比，试点期间报告的违规数量显著减少（4.5 与 11，p=0.04）。干预后提交的总比例没有显著差异（85%与 82%，p=0.42）。PGY1 的平均提交率在试点期间下降（91%-75%，p=0.21），而 PGY2 的提交率上升（77%-91%，p=0.07）。与历史数据相比，2018/2019 学年和 2019/2020 学年的总提交率总体上有所增加（74%与 79%，p=0.047），每月违规的平均数量也有所减少（14 与 6.25，p=0.004）。有 13 名（50%）住院医师（8 名 PGY1，5 名 PGY2）自愿接受半结构化访谈。大多数参与者认为该应用程序对记录和报告临床工作时间很有用。他们注意到管理负担减轻，并且由于自动记录，报告更准确。使用该应用程序不会被认为会限制与患者护理的接触；然而，存在隐私问题，并且确定了一些技术障碍。该应用程序使用的信息传达被认为对实施很重要。
我们计划中地理围栏应用程序提供的“实时”数据有助于减少报告的工作时间违规数量，并且不会减少住院医师与患者护理的接触。减少记录工作时间的管理负担，同时提高提交的透明度和准确性可能是重要的机制。
