Lazaro Tyler T, Katlowitz Kalman A, Karas Patrick J, Srinivasan Visish M, Walls Ellen, Collier Gina, Raza Shaan M, Curry Daniel J, Ropper Alexander E, Fuentes Alfonso, Gopinath Shankar P, Rao Ganesh, Patel Akash J
1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
3Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas.
J Neurosurg. 2022 Sep 9;138(4):1117-1123. doi: 10.3171/2022.4.JNS212612. Print 2023 Apr 1.
Since the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions in 2003, many residency programs have adopted a night float system to comply with time constraints. However, some surgical subspecialities have been concerned that use of a night float system deprives residents of operative experience. In this study, the authors describe their training program's transition to a night float system and its impact on resident operative experience.
The authors conducted a single-program study of resident surgical case volume before and after implementing the night float system at 3 of their 5 hospitals from 2014 to 2020. The authors obtained surgical case numbers from the ACGME case log database.
Junior residents received a concentrated educational experience, whereas senior residents saw a significant decrease from 112 calls/year to 17. Logged cases significantly increased after implementation of the night float system (8846 vs 10,547, p = 0.04), whereas cases at non-night float hospitals remained the same. This increase was concurrent with an increase in hospital cases. This difference was mainly driven by senior resident cases (p = 0.010), as junior and chief residents did not show significant differences in logged cases (p > 0.40). Lead resident cases increased significantly after implementation of the night float system (6852 vs 8860, p = 0.04). When normalized for increased hospital cases, resident case increases were not statistically significant.
Transitioning to a night float call system at the authors' institution increased overall resident operative cases, particularly for lead resident surgeons. Based on the results of this study, the authors recommend the use of a night float call system to consolidate night calls, which increases junior resident-level educational opportunities and senior resident cases.
自毕业后医学教育认证委员会（ACGME）于2003年实施工作时间限制以来，许多住院医师培训项目采用了夜间轮值制度以符合时间限制。然而，一些外科亚专业担心夜间轮值制度会剥夺住院医师的手术经验。在本研究中，作者描述了他们的培训项目向夜间轮值制度的转变及其对住院医师手术经验的影响。
作者对2014年至2020年期间其5家医院中的3家实施夜间轮值制度前后的住院医师手术病例数量进行了单项目研究。作者从ACGME病例日志数据库中获取手术病例数量。
低年资住院医师获得了集中的教育体验，而高年资住院医师的值班次数从每年112次显著减少至17次。夜间轮值制度实施后，记录的病例显著增加（8846例对10547例，p = 0.04），而非夜间轮值医院的病例数保持不变。这种增加与医院病例数的增加同时发生。这种差异主要由高年资住院医师的病例数驱动（p = 0.010），因为低年资和总住院医师的记录病例数没有显著差异（p > 0.40）。总住院医师的病例数在夜间轮值制度实施后显著增加（6852例对8860例，p = 0.04）。在考虑到医院病例数增加的情况下进行标准化后，住院医师病例数的增加没有统计学意义。
作者所在机构向夜间轮值呼叫系统的转变增加了住院医师的总体手术病例数，特别是对于总住院医师外科医生。基于本研究的结果，作者建议使用夜间轮值呼叫系统来整合夜间值班，这增加了低年资住院医师级别的教育机会和高年资住院医师的病例数。
