Conigliaro J, Frishman W H, Lazar E J, Croen L
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
J Gen Intern Med. 1993 Sep;8(9):502-7. doi: 10.1007/BF02600112.
To assess the attitudes of internal medicine housestaff and their attending physicians regarding the impact of the reduction in on-call working hours and increased supervision mandated in New York by a revision of the State Health Code (Section 405).
Survey of senior medical housestaff and attendings two years after the adoption of the mandated changes.
Two independent medicine housestaff training programs of the Albert Einstein College of Medicine in the Bronx, New York.
Fifty-three percent of third- and fourth-year residents (n = 79) and 60% of voluntary and full-time attendings (n = 266) responded.
A factor analysis of 13 variables that appeared on both versions of the survey identified two interpretable factors. A multivariate analysis of variance compared responses to each factor by group and by campus, and Bonferroni post-hoc comparisons analyzed the items within factors. Chi-square analyses compared responses of residents and attendings to the open-ended questions.
Significant differences between the housestaff and attendings groups were found for all fixed-response items (minimum p < 0.05 for all analyses), but both groups agreed that the regulations had a positive impact on resident attitudes regarding the demands on their time. Both groups were also uncertain whether the new regulations had a beneficial effect on the choice of internal medicine as a career, the quality of resident supervision, and residents' intellectual interest in challenging medical problems. Whereas residents agreed that the regulations diminished their fatigue, had no impact on their ability to observe the full impact of interventions on patients, and resulted in better patient care, attendings were uncertain or disagreed. While attendings agreed that the regulations had caused a shift-work mentality among residents, housestaff were uncertain.
Housestaff had more positive attitudes about the impact of the mandated changes in working conditions for residents than did attending physicians in the same institutions. The major benefits seen by residents were less fatigue and more spare time. There was no consensus about whether these changes had a positive impact on internal medicine practice and clinical supervision. There was some concern that a shift-work mentality is developing among residents and that continuity of patient care has suffered. Thus, despite some substantial benefits, Section 405 may not be achieving its goals of improving resident supervision and the quality of patient care by houseofficers.
评估内科住院医师及其主治医生对于纽约州卫生法规修订案（第405条）所规定的减少值班工作时间及加强监管措施的影响的态度。
在强制变更实施两年后对高级内科住院医师和主治医生进行调查。
纽约布朗克斯区阿尔伯特·爱因斯坦医学院的两个独立的内科住院医师培训项目。
79名三、四年级住院医师中的53%（n = 79）以及266名志愿和全职主治医生中的60%（n = 266）做出了回应。
对调查问卷两个版本中出现的13个变量进行因子分析，确定了两个可解释的因子。多变量方差分析按组和校区比较了对每个因子的回答，Bonferroni事后比较分析了因子内的项目。卡方分析比较了住院医师和主治医生对开放式问题的回答。
在所有固定回答项目上，住院医师组和主治医生组之间均存在显著差异（所有分析的最小p值<0.05），但两组均认为这些规定对住院医师对时间要求的态度产生了积极影响。两组也都不确定新规定对选择内科作为职业、住院医师监管质量以及住院医师对具有挑战性的医疗问题的学术兴趣是否有有益影响。住院医师同意这些规定减轻了他们的疲劳，对他们观察干预措施对患者的全面影响的能力没有影响，并带来了更好的患者护理，而主治医生则不确定或不同意。虽然主治医生同意这些规定使住院医师产生了轮班工作心态，但住院医师并不确定。
与同一机构的主治医生相比，住院医师对强制变更住院医师工作条件的影响持更积极的态度。住院医师认为主要的好处是疲劳减轻和业余时间增多。对于这些变更是否对内科实践和临床监管有积极影响，没有达成共识。有人担心住院医师中正在形成轮班工作心态，并且患者护理的连续性受到了影响。因此，尽管有一些显著的好处，但第405条可能无法实现其改善住院医师监管和住院医生患者护理质量的目标。
