Ashraf Hamza, Gunda Deepika, Morgan F Hamish, Ashraf Gizem, Cortez Alexander R, Muralidharan Vijayaragavan, Stevens Sean
Department of Surgery, Austin Hospital, Victoria, Australia.
Department of Surgery, Albury-Wodonga Health, New South Wales, Australia.
Surg Pract Sci. 2023 Oct 17;15:100222. doi: 10.1016/j.sipas.2023.100222. eCollection 2023 Dec.
Work hour restrictions (WHR) have been implemented globally to improve resident safety and welfare, but many in the surgical community have raised concerns regarding the impact on resident education and operative experience. This systematic review aims to investigate the impact of WHR on general surgical resident operative caseload.
Medline and Embase databases were systematically searched according to PRISMA guidelines to identify articles published between 2003 and 2022 assessing the impact of WHR on the operative experience of general surgical residents. Articles were only included if they reported on quantitative measures of operative experience and examined operative caseload after the introduction of WHR.
Of 1,266 studies identified, 26 studies were included, with the majority from US literature. Total major cases underwent a 0.6 % decrease after the introduction of WHR, with surgeon chief cases undergoing a 3.3 % decrease and surgeon junior cases undergoing a 3.7 % increase. Operative trauma underwent the greatest decrease at 18.4 %. Skin & soft tissue cases underwent the greatest increase at 67.6 %.
While WHR were often associated with reduced operative caseload in the early years following implementation, the majority of studies found a significant reduction was avoided in the long-term as training programs likely adapted to the new environment. These findings are of particular significance to countries considering the introduction of WHR for surgical residents and may guide future policy and decision-making.
This review demonstrated no significant change in total major cases and an increased caseload for most operative subcategories after the introduction of WHR for general surgical residents. These findings are in keeping with a previous review published in 2011.
全球已实施工作时间限制（WHR）以提高住院医师的安全和福利，但外科界许多人对其对住院医师教育和手术经验的影响表示担忧。本系统评价旨在调查工作时间限制对普通外科住院医师手术病例数量的影响。
根据PRISMA指南，系统检索Medline和Embase数据库，以识别2003年至2022年期间发表的评估工作时间限制对普通外科住院医师手术经验影响的文章。只有在报告了手术经验的定量测量并在引入工作时间限制后检查了手术病例数量的文章才被纳入。
在识别出的1266项研究中，纳入了26项研究，其中大多数来自美国文献。引入工作时间限制后，主要病例总数下降了0.6%，主刀医师的病例下降了3.3%，初级医师的病例增加了3.7%。手术创伤下降幅度最大，为18.4%。皮肤及软组织病例增加幅度最大，为67.6%。
虽然在实施工作时间限制后的最初几年，工作时间限制通常与手术病例数量减少有关，但大多数研究发现，从长期来看，由于培训计划可能适应了新环境，显著减少的情况得以避免。这些发现对于考虑为外科住院医师引入工作时间限制的国家具有特别重要的意义，并可能指导未来的政策和决策。
本综述表明，对普通外科住院医师引入工作时间限制后，主要病例总数没有显著变化，大多数手术亚类的病例数量有所增加。这些发现与2011年发表的先前综述一致。
