Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
J Surg Educ. 2022 Nov-Dec;79(6):e17-e24. doi: 10.1016/j.jsurg.2022.05.016. Epub 2022 Jun 10.
The conflict between prioritizing education for surgical trainees, promoting trainee wellness, and maintaining optimal patient care has remained challenging since the introduction of the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions in 2003. There is still a dearth of research examining which interventions successfully enable duty hour adherence. This study assessed the impact of a combination of strategic interventions on improving clinical work hour adherence.
Monthly clinical work hour submission rates were assessed for all general surgery residents at a single university-based residency program over a 3-year period (2018-2021). Interventions targeted 3 domains and were implemented between academic years 2018 to 2019 (control) and 2020 to 2021 (intervention): 1) improving the accuracy and transparency of work hour reporting, 2) facilitating more timely interventions, and 3) structural scheduling changes. All 80-hour work week and continuous work hour violations were assessed. Findings were also compared to the corresponding ACGME Resident Survey results.
There was no significant difference in the rate of monthly work hour submissions pre- and postintervention (78% vs 75%, p = 0.057). However, the number of total reported monthly violations decreased significantly (mean 13.8 vs 2.4, p < 0.01), including decreases in both 80-hour work week and continuous work hour violations (mean 4.7 vs 1.6, p < 0.001 and 9.1 vs 0.8, p < 0.001, respectively). Reported compliance also increased on the annual ACGME resident surveys, where 61% vs 95% of residents felt they were compliant with the 80-hour work week and 71% vs 95% felt they were compliant with the continuous work hours (2018-19 vs 2020-21).
Innovative strategies addressing schedule changes, the culture of work hour reporting, and early intervention significantly decreased the number of duty hour violations at our institution. Reported resident compliance also improved based on ACGME Resident Survey data. These data may inform similar multifaceted approaches at other institutions to improve overall work hour adherence.
自 2003 年《住院医师规范化培训评估委员会（ACGME）》工作时间限制出台以来，优先考虑外科住院医师教育、促进住院医师健康以及保持最佳患者护理之间的冲突一直具有挑战性。目前仍缺乏研究来检验哪些干预措施能成功地确保遵守工作时间限制。本研究评估了一系列战略干预措施结合使用对改善临床工作时间遵守情况的影响。
在 3 年期间（2018-2021 年），对某单一大学附属医院住院医师培训项目的所有普外科住院医师每月临床工作时间提交情况进行评估。干预措施针对 3 个领域，并在 2018 至 2019 学年（对照）和 2020 至 2021 学年（干预）实施：1）提高工作时间报告的准确性和透明度，2）促进更及时的干预，3）结构排班变更。所有 80 小时工作周和连续工作小时违规情况都进行了评估。研究结果还与相应的《住院医师调查》结果进行了比较。
干预前后每月工作时间提交率无显著差异（78%与 75%，p=0.057）。但是，总的报告违规月数显著减少（平均 13.8 与 2.4，p<0.01），包括 80 小时工作周和连续工作小时违规数减少（平均 4.7 与 1.6，p<0.001 和 9.1 与 0.8，p<0.001，分别）。《住院医师调查》年度调查显示，住院医师对遵守 80 小时工作周的自我报告也有所增加，分别有 61%与 95%的住院医师认为他们遵守了 80 小时工作周，71%与 95%的住院医师认为他们遵守了连续工作时间（2018-19 年与 2020-21 年）。
解决排班变更、工作时间报告文化和早期干预的创新策略显著减少了我院的工时违规行为数量。根据《住院医师调查》数据，住院医师自我报告的合规性也有所提高。这些数据可能为其他机构提供信息，帮助其采取类似的多方面方法来提高整体工作时间遵守情况。
