To Leave or to Lie? Are Concerns about a Shift-Work Mentality and Eroding Professionalism as a Result of Duty-Hour Rules Justified?
To Leave or to Lie? Are Concerns about a Shift-Work Mentality and Eroding Professionalism as a Result of Duty-Hour Rules Justified?
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DOI：
10.1111/j.1468-0009.2010.00603.x
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发表时间：
2010-09-01
影响因子：
6.6
通讯作者：
Bosk, Charles L.
中科院分区：
文献类型：
--
作者：
Szymczak, Julia E.;Brooks, Joanna Veazey;Bosk, Charles L.
方法：2008年，我们对内科和普外科住院医生在两家附属于相同培训计划的医院进行了为期三个月的人种学观察，并对17名住院医生进行了深入访谈。对实地笔记和访谈记录进行分析，以了解他们在开始和离开工作、报告值班时间和表达对人力资源的看法和行为方面的看法和行为。调查结果：受访者在工作中没有表现出“倒班”心态。我们发现，住院医生：(1)偶尔为了完成病人护理任务而留在医院，即使根据时钟，他们被要求离开，因为组织文化强调彻底地完成工作；(2)不盲目接受不遵守DHR的规定，但考虑到规则中固有的权衡；(3)表达了错误报告值班时间的微妙和复杂的原因，表明报告工作时间不是一个简单的撒谎或说真话的问题。结论：对DHR的担忧可能被夸大了，以及由于养成“轮班工作”的心态而导致的住院医生专业精神的侵蚀。相反，DHR对职业精神的影响比传统智慧所暗示的要复杂得多，需要额外的评估。
Methods: In 2008, we conducted three months of ethnographic observation of internal medicine and general surgery residents as they went about their everyday work in two hospitals affiliated with the same training program, as well as in-depth interviews with seventeen residents. Field notes and interview transcripts were analyzed for perceptions and behaviors in regard to beginning and leaving work, reporting duty hours, and expressing opinions about DHR.Findings: The respondents did not exhibit a "shift work" mentality in relation to their work. We found that residents: (1) occasionally stay in the hospital in order to complete patient care tasks even when, according to the clock, they are required to leave, because the organizational culture stresses performing work thoroughly, (2) do not blindly embrace noncompliance with DHR but are thoughtful about the tradeoffs inherent in the regulations, and (3) express nuanced and complex reasons for erroneously reporting duty hours, suggesting that reporting hours worked is not a simple issue of lying or truth telling.Conclusions: Concerns about DHR and the erosion of resident professionalism resulting from the development of a "shift work" mentality likely have been overstated. Instead, the influence of DHR on professionalism is more complex than the conventional wisdom suggests and requires additional assessment.