Effects of work hour reduction on residents' lives - A systematic review
Effects of work hour reduction on residents' lives - A systematic review
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DOI：
10.1001/jama.294.9.1088
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发表时间：
2005-09-07
影响因子：
120.7
通讯作者：
Saint, S
中科院分区：
文献类型：
--
作者：
Fletcher, KE;Underwood, W;Saint, S
研究生医学教育认证理事会于2003年7月实施了强制性的工作时间限制，部分原因是出于对睡眠剥夺环境中居民健康的关注。这些限制也可能对居民生活的其他方面产生影响。目的总结有关干预措施减少居民工作时间对居民教育和生活质量的影响的文献。数据来源我们使用MEDLINE、EMBASE和Current Contents检索了1966年至2005年4月有关居民工作时间的英文文献。研究选择研究被包括在内，评估了旨在抵消住院医师工作时间、疲劳或睡眠剥夺的影响的系统变化;包括了与住院医师直接相关的结果;并在美国进行。数据提取对于每项纳入的研究，2名研究者使用标准数据提取表独立提取与研究质量、受试者、干预措施和发现相关的数据。数据合成54篇文章符合纳入标准。用于减少住院医师工作时间的干预措施各不相同，但包括昼夜浮动团队，额外的交叉覆盖和医生扩展。结果包括住院医师教育指标（手术经验、测试成绩、满意度）和住院医师生活质量（睡眠量、幸福感）。干预措施，以减少居民的工作时间导致手术经验和感知的教育质量的混合效果，但普遍提高居民的生活质量。许多研究有重大的局限性，在他们的设计或conduct.Conclusions过去的干预措施表明，居民的生活质量可能会提高与工作时间的限制，但这些研究的结果的解释是阻碍了次优的研究设计和使用nonvalidated仪器。减少居民工作时间对教育的长期影响仍然未知。目前和未来的干预措施应该用更严格的方法进行评估，并应该调查居民生活质量和病人护理质量之间的联系。
Context The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' wellbeing in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents.Objective To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life.Data Sources We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings.Study Selection Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States.Data Extraction For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form.Data Synthesis Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct.Conclusions Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.