Surgical Residents' Perceptions of 2011 Accreditation Council for Graduate Medical Education Duty Hour Regulations
Surgical Residents' Perceptions of 2011 Accreditation Council for Graduate Medical Education Duty Hour Regulations
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DOI：
10.1001/jamasurg.2013.169
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发表时间：
2013-05-01
期刊：
影响因子：
16.9
通讯作者：
Cioffi, William G.
中科院分区：
文献类型：
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作者：
Drolet, Brian C.;Sangisetty, Suma;Cioffi, William G.
重要性：2010 年，研究生医学教育认证委员会 (ACGME) 提议加强对住院医师工作时间和监督的监管。 2011 年 7 月生效的新通用计划要求极大地改变了惯用的 24 小时内部呼叫时间表。外科住院医生更有可能受到这些工作时间限制的影响。目的：调查 2011 年 7 月实施后外科住院医生对 2011 年 ACGME 共同计划要求的看法。设计：在 2011 年 ACGME 法规实施 6 个月后，对 123 个参与机构进行了一项包含 20 个问题的电子调查。地点：美国和美国领地的 ACGME 认可的教学医院。参与者：总样本为1013 名自愿参加 ACGME 认可机构的普通外科和外科专科住院医师。主要结果和措施：住院医师在实施 2011 年 ACGME 值班时间规定后对教育、患者护理和生活质量变化的看法以及他们对这些规定的遵守情况。结果：从 6202 名调查受访者的人口代表性样本中确定了 1013 名接受普通外科或外科亚专科培训的住院医师子集。大多数外科住院医生表示，2011 年规定实施后，教育（55.1%）、高级职位准备（68.4%）和工作安排（50.7%）都变差。他们报告说，监督（80.8%）、患者护理安全（53.4%）或休息时间（57.8%）没有变化。尽管实习生的生活质量被认为更好（61.9%），但大多数居民认为老年居民的生活质量更差（54.4%）。大多数人报告增加了交接（78.2%）并将初级职责转移给高级住院医师（68.7%）。最后，许多住院医师报告存在不合规情况 (67.6%) 和伪造工作时间 (62.1%)。结论和相关性：大多数外科住院医师不赞成 2011 年 ACGME 通用计划要求 (65.9%)。增加工作时间限制的拟议好处——改善教育、患者护理和生活质量——表面上并没有在外科培训中得到证实。根据 2011 年 ACGME 法规，住院医师（尤其是外科领域的住院医师）可能很难学习和护理患者。
Importance: In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.Objective: To examine surgical residents' views of the 2011 ACGME Common Program requirements after implementation in July 2011.Design: A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.Setting: ACGME-accredited teaching hospitals in the United States and US territories.Participants: The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.Main Outcomes and Measures: Residents' perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.Results: A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).Conclusions and Relevance: A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions-improved education, patient care, and quality of life-have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.