Nagasaki Kazuya, Nishizaki Yuji, Hachisuka Chisato, Shinozaki Tomohiro, Shimizu Taro, Yamamoto Yu, Shikino Kiyoshi, Fukui Sho, Nishiguchi Sho, Katayama Kohta, Kurihara Masaru, Kobayashi Hiroyuki, Tokuda Yasuharu
Department of Internal Medicine, Mito Kyodo General Hospital University of Tsukuba Ibaraki Japan.
Division of Medical Education Juntendo University School of Medicine Tokyo Japan.
J Gen Fam Med. 2022 Nov 23;24(2):87-93. doi: 10.1002/jgf2.594. eCollection 2023 Mar.
The effect of duty hour (DH) restrictions on postgraduate residents' acquisition of clinical competencies is unclear. We evaluated the relationship between DHs and competency-related knowledge acquisition using the General Medicine In-training Examination (GM-ITE).
We conducted a multicenter, cross-sectional study of community hospital residents among 2019 GM-ITE examinees. Self-reported average DHs per week were classified into five DH categories and the competency domains were classified into four areas: symptomatology and clinical reasoning (CR), physical examination and clinical procedure (PP), medical interview and professionalism (MP), and disease knowledge (DK). The association between these scores and DHs was examined using random-intercept linear models with and without adjustment for confounding factors.
We included 4753 participants in the analyses. Of these, 31% were women, and 49.1% were in the postgraduate year (PGY) 2. Mean CR and MP scores were lower among residents in Category 1 (<50 h) than in residents in Category 3 (≥60 and <70 h; reference group). Mean DK scores were lower among residents in Categories 1 and 2 (≥50 and <60 h) than in the reference group. PGY-2 residents in Categories 1 and 2 had lower CR scores than those in Category 3; however, PGY-1 residents in Category 5 showed higher scores.
The relationship between DHs and each competency area is not strictly linear. The acquisition of knowledge of physical examination and clinical procedures skills in particular may not be related to DHs.
值班时长（DH）限制对研究生住院医师临床能力获取的影响尚不清楚。我们使用普通内科住院医师培训考试（GM - ITE）评估了值班时长与能力相关知识获取之间的关系。
我们对2019年GM - ITE考生中的社区医院住院医师进行了一项多中心横断面研究。将自我报告的每周平均值班时长分为五个值班时长类别，能力领域分为四个方面：症状学与临床推理（CR）、体格检查与临床操作（PP）、医学问诊与职业素养（MP）以及疾病知识（DK）。使用随机截距线性模型检查这些分数与值班时长之间的关联，模型分别调整和未调整混杂因素。
我们纳入了4753名参与者进行分析。其中，31%为女性，49.1%处于研究生二年级（PGY2）。第1类（<50小时）住院医师的平均CR和MP分数低于第3类（≥60且<70小时；参照组）住院医师。第1类和第2类（≥50且<60小时）住院医师的平均DK分数低于参照组。第1类和第2类中的PGY2住院医师的CR分数低于第3类；然而，第5类中的PGY1住院医师分数更高。
值班时长与每个能力领域之间的关系并非严格线性。尤其是体格检查和临床操作技能知识的获取可能与值班时长无关。
