Wols M, Kramer D, Strange G R
University of Illinois College of Medicine, Chicago, USA.
Acad Emerg Med. 1995 Feb;2(2):124-7. doi: 10.1111/j.1553-2712.1995.tb03176.x.
The number of hours worked by residents in all specialties has become a controversial issue. Residents often are expected to competently conduct patient care activities and to take educational advantage of clinical experiences in spite of frequent fatigue and sleep deprivation. This survey of residency directors was designed to assess the scheduled clinical time for emergency medicine (EM) residents.
A 13-question survey dealing with time commitments of EM residents was sent to the residency directors of all accredited EM residency programs in the United States in the fall of 1991. Residency directors were asked to indicate the number of shifts, hours, and days off per week; and the number of night shifts and weekend days off per month for each postgraduate year of residency training (PGY1-PGY4). Directors also were asked whether shifts were scheduled randomly or predictably with progression from days to nights with time off after nights.
Seventy of 71 (98.6% response rate) residency directors responded. Residents were scheduled for an average of 49.1 hours per week. Scheduled hours decreased from an average of 51.9 at the PGY1 level to an average of 44.5 at the PGY4 level. A similar progression with year of training was noted for scheduled night shifts/month, days off/week, and weekend days off/month. A PGY1 trainee averaged 7.0 night shifts/month, 1.9 days off/week, and 3.0 weekend days off/month; while a PGY4 trainee averaged 5.3, 2.4, and 3.2, respectively. Only 40% of the directors reported predictable scheduling progressing from days to nights.
Emergency medicine resident schedules, as reported by residency directors, fall well within current specialty-specific requirements and compare favorably with the reported numbers for other specialties. However, because large ranges in scheduling parameters were reported, the data may be of value to residency directors, residents, and prospective residents. Most programs did not report a predictable schedule progression of shifts.
各专业住院医师的工作时长已成为一个颇具争议的问题。尽管经常感到疲劳和睡眠不足，但人们通常期望住院医师能够胜任患者护理工作，并从临床经验中获取教育收益。本次针对住院医师培训项目主任的调查旨在评估急诊医学（EM）住院医师的预定临床工作时间。
1991年秋季，一份包含13个关于急诊医学住院医师时间安排问题的调查问卷被发送给了美国所有经认可的急诊医学住院医师培训项目的主任。要求住院医师培训项目主任指出每周的班次数量、工作时长和休息日数量；以及住院医师培训（PGY1 - PGY4）各研究生阶段每月的夜班数量和周末休息日数量。还询问主任们班次安排是随机的还是可预测的，即是否从白班逐渐过渡到夜班，且夜班后有休息时间。
71位住院医师培训项目主任中有70位（回复率为98.6%）做出了回应。住院医师每周的预定工作时长平均为49.1小时。预定工作时长从PGY1阶段的平均51.9小时降至PGY4阶段的平均44.5小时。在每月预定夜班数量、每周休息日数量和每月周末休息日数量方面，也观察到了与培训年份类似的变化趋势。一名PGY1实习生平均每月值7.0个夜班，每周休息1.9天，每月有3.0个周末休息日；而一名PGY4实习生平均分别为5.3个、2.4个和3.2个。只有40%的主任报告称班次安排是从白班逐渐过渡到夜班且可预测的。
根据住院医师培训项目主任的报告，急诊医学住院医师的排班完全符合当前特定专业的要求，并且与其他专业报告的数字相比具有优势。然而，由于报告的排班参数范围较大，这些数据可能对住院医师培训项目主任、住院医师以及未来的住院医师具有参考价值。大多数项目并未报告班次安排的可预测进展情况。
