Scapa Jason V, Naini Bita V, Pullarkat Sheeja, Sullivan Peggy S
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
Acad Pathol. 2023 Jul 14;10(3):100087. doi: 10.1016/j.acpath.2023.100087. eCollection 2023 Jul-Sep.
Scheduling rotations for a pathology training program involves balancing educational requirements, service coverage, and paid time off (PTO). Absences can affect training as residents cross-cover, managing multiple services at once. Other specialties utilize a "Jeopardy" based system for covering absences. In this system, residents on outpatient services are "jeopardized" to cover inpatient services for trainee absences. Borrowing this concept, we created a schedule model with a "Jeopardy-Elective" (JE) rotation to support resident absences. Prior to 2018-19, our residency program consisted of a 12 month-long rotation schedule. We adopted a 13 four-week block rotation model system, adding four JE rotations per resident over the course of training. The JE resident covered services during trainee absences and spent the remaining rotation on elective. We then conducted a pre- and post-intervention survey of all residents who trained in both systems. Following the change in schedule model, our results showed a statistically significant increase in resident satisfaction with taking PTO (p = 0.0014), finding coverage (p = 0.0006), and taking a sick day (p = 0.03). The mean number of days covered by the JE resident was 8.5 ± 2.7 workdays (out of 20). PTO usage increased from 16 to 20 days/resident while mean number of sick days decreased from 1.7 to 1.3 days per resident. There was overwhelming support with 82% of residents wanting to retain the new system going forward. Through use of the JE rotation, our program improved service coverage issues and resident satisfaction, with the long-term goal of enhanced resident well-being and enriched resident learning experiences.
为病理学培训项目安排轮转需要平衡教育要求、服务覆盖以及带薪休假（PTO）。由于住院医师要交叉负责多项服务，缺勤会影响培训。其他专业采用基于“危险边缘”的系统来应对缺勤情况。在这个系统中，门诊服务的住院医师会被“危及”去承担因实习生缺勤而产生的住院服务。借鉴这个概念，我们创建了一个带有“危险边缘 - 选修”（JE）轮转的排班模型来支持住院医师的缺勤。在2018 - 19学年之前，我们的住院医师培训项目采用为期12个月的轮转排班。我们采用了13个四周模块的轮转模型系统，在培训过程中每位住院医师增加了4次JE轮转。JE住院医师在实习生缺勤时承担服务，并将剩余的轮转时间用于选修。然后我们对在这两种系统中都接受过培训的所有住院医师进行了干预前后的调查。排班模型改变后，我们的结果显示住院医师在使用PTO（p = 0.0014）、找到替班（p = 0.0006）以及请病假（p = 0.03）方面的满意度有统计学意义的显著提高。JE住院医师平均承担的天数为8.5 ± 2.7个工作日（共20个工作日）。PTO的使用从每位住院医师16天增加到20天，而平均病假天数从每位住院医师1.7天减少到1.3天。有82%的住院医师表示强烈支持并希望继续保留新系统。通过使用JE轮转，我们的项目改善了服务覆盖问题和住院医师满意度，长期目标是提高住院医师的幸福感并丰富住院医师的学习体验。
