Burnout and internal medicine resident work-hour restrictions
Burnout and internal medicine resident work-hour restrictions
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DOI：
10.1001/archinte.165.22.2595
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发表时间：
2005-12-12
影响因子：
--
通讯作者：
Prochazka, AV
中科院分区：
文献类型：
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作者：
Gopal, R;Glasheen, JJ;Prochazka, AV
背景：倦怠在内科住院医师中非常普遍。自2003年7月起，所有住院医生每周平均工作时间不得超过80小时，连续照顾病人和履行教育义务的时间不得超过30小时。我们评估了烧伤率在内科住院医师之前和之后实施新的工作时间restriction.Methods：大学的科罗拉多健康科学中心内科住院医师进行了调查，在2003年5月和2004年5月。该调查包含Maslach倦怠量表，分为3个分量表（即情绪衰竭、人格解体和个人成就感）;精神障碍抑郁筛查的初级保健评估;以及自我报告的护理和教育质量。2003年和2004年的答复率分别为87%（139名居民中的121名）和74%（143名居民中的106名）。自我报告的工作时间从平均74.6小时下降到67.1小时（P= 0.003）。2004年，13%的居民经历了高度的情绪疲惫（42%对29%; P= 0.03）。有一种趋势，即具有高度人格解体的居民较少（61%对55%; P= 0.13），具有积极抑郁筛查的居民较少（51%对41%; P= 0.11）。个人成就没有改变。自我报告的护理质量的评估没有显着变化，从2003年到2004年。居民报告每月参加较少的教育会议（18.99 vs 15.56; P=.01）。总体居住满意度下降6毫米的100毫米视觉模拟评分（P= 0.02）。结论：倦怠仍然是一个主要问题。减少工作时间可能是减少倦怠的第一步，但也可能影响教育和护理质量。
Background: Burnout is very common in internal medicine residents. Effective July 2003, all residents were restricted to work less than an average of 80 hours per week and no more than 30 hours of continuous duty for patient care and educational obligations. We evaluated rates of burn-out in internal medicine residents before and after the implementation of the new work-hour restriction.Methods: University of Colorado Health Science Center internal medicine residents were surveyed in May 2003 and May 2004. The survey contained the Maslach Burnout Inventory, organized into 3 subscales (ie, emotional exhaustion, depersonalization, and personal accomplishment); the Primary Care Evaluation of Mental Disorders depression screen; and self-reported quality of care and education.Results: The response rate was 87% (121 of 139 residents) and 74% (106 of 143 residents) in 2003 and 2004, respectively. Self-reported hours worked decreased from a mean of 74.6 to 67.1 (P=.003). In 2004, 13% fewer residents experienced high emotional exhaustion (42% vs 29%; P=.03). There was a trend toward fewer residents with high depersonalization (61% vs 55%; P=.13) and fewer residents with a positive depression screen (51% vs 41%; P=.11). Personal accomplishment did not change. The assessment of self-reported quality of care did not significantly change from 2003 to 2004. Residents reported attending fewer educational conferences per month (18.99 vs 15.56; P=.01). Overall residency satisfaction decreased 6 mm on a 100-mm visual analogue score (P=.02).Conclusions: Burnout continues to be a major problem. Reducing hours may be the first step to reduce burnout but may also affect education and quality of care.