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Duty hours restriction

Catherine de Blacam, Sean Tierney, Odhran Shelley
BACKGROUND: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity...
October 20, 2016: Journal of Plastic Surgery and Hand Surgery
Henry Hoffmann, Daniel Oertli, Robert Mechera, Salome Dell-Kuster, Rachel Rosenthal, Richard Reznick, Hugh MacDonald
OBJECTIVE: Quality of surgical training in the era of resident duty-hour restrictions (RDHR) is part of an ongoing debate. Most training elements are provided during surgical service. As exposure to surgical procedures is important but time-consuming, RDHR may affect quality of surgical training. Providing structured training elements may help to compensate for this shortcoming. DESIGN: This binational anonymous questionnaire-based study evaluates frequency, time, and structure of surgical training programs at 2 typical academic teaching hospitals with different RDHR...
September 30, 2016: Journal of Surgical Education
Jocelyn Schiller, Max Sokoloff, Chosang Tendhar, John Schmidt, Jennifer Christner
BACKGROUND: The purpose of this mixed-methods study was to investigate whether increased night shifts for students on paediatric rotations had any negative impact on their overall quality of educational experiences in light of the implementation of duty-hour restrictions. METHODS: Both quantitative and qualitative data were collected from 30 students on paediatric rotations during the academic year 2011/12. Students completed two questionnaires, one in response to their experiences during the day shifts and another in response to their experiences during the night shifts...
August 23, 2016: Clinical Teacher
Shunaha Kim-Fine, Erin A Brennand
Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy...
September 2016: Obstetrics and Gynecology Clinics of North America
Ryan M Antiel, Thane A Blinman
No abstract text is available yet for this article.
September 2016: American Journal of Bioethics: AJOB
Andrew Moeller, Jordan Webber, Ian Epstein
BACKGROUND: Resident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains...
2016: BMC Medical Education
Lily V Saadat, Allison R Dahlke, Ravi Rajaram, Lindsey Kreutzer, Remi Love, David D Odell, Karl Y Bilimoria, Anthony D Yang
BACKGROUND: The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period...
June 2016: Journal of the American College of Surgeons
David Ouyang, Jonathan H Chen, Gomathi Krishnan, Jason Hom, Ronald Witteles, Jeffrey Chi
BACKGROUND: It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigated whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work more than 80 hours per week. METHODS: We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014...
September 2016: American Journal of Medicine
Rebecca M Rentea, Jared A Forrester, Nathan W Kugler, Anahita Dua, Travis P Webb
Restriction of resident duty hours has resulted in the implementation of night float systems in surgical and medical programs. Many papers have examined the benefits and structure of night float, but few have addressed patient safety issues, quality patient care, and the impact on the residency education system. The objective of this review is to provide practical tips to optimize the night float experience for resident training while continuing to emphasize patient care. The tips provided are based on the experiences and reflections of residents, supervising staff, group discussions, and the available literature in a hospital-based general surgery residency program...
June 2015: WMJ: Official Publication of the State Medical Society of Wisconsin
Ralph C Quillin, Alexander R Cortez, Timothy A Pritts, Dennis J Hanseman, Michael J Edwards, Bradley R Davis
BACKGROUND: The ACGME instituted duty hour restrictions in 2003. This presents a challenge for surgical residents who must acquire a medical and technical knowledge base during their training. Although the effect of work hour limitations on operative volume has been examined, no study has examined whether duty hour reform has had an effect on operative volume variability. STUDY DESIGN: The ACGME operative log data of graduating general surgery residents from 1992 to 2015 were examined...
June 2016: Journal of the American College of Surgeons
Amy B Fraser, Emma J Stodel, Alan J Chaput
PURPOSE: Certain pressures stemming from within the medical community and from society in general, such as the need for increased accountability in resident training and restricted resident duty hours, have prompted a re-examination of methods for training physicians. Leaders in medical education in North America and around the world champion competency-based medical education (CBME) as a solution. The Department of Anesthesiology at the University of Ottawa launched Canada's first CBME program for anesthesiology residents on July 1, 2015...
July 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Karl Y Bilimoria, Jeanette W Chung, Larry V Hedges, Allison R Dahlke, Remi Love, Mark E Cohen, David B Hoyt, Anthony D Yang, John L Tarpley, John D Mellinger, David M Mahvi, Rachel R Kelz, Clifford Y Ko, David D Odell, Jonah J Stulberg, Frank R Lewis
BACKGROUND: Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS: We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group)...
February 25, 2016: New England Journal of Medicine
Neelaysh Vukkadala, Andrew Auerbach, Judith H Maselli, Glenn Rosenbluth
Duty-hour restrictions have forced changes in care models for inpatient services, including an increase in shift work. In this study we aimed to determine whether a shift model compliant with 2011 Accreditation Council for Graduate Medical Education duty-hour standards was associated with more active patient care management. Residents caring for pediatric patients changed from a schedule with extended duty shifts and cross-coverage to one based on day/night shifts, limiting interns to 16 consecutive duty hours...
March 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Carla M Ziebertz, Madelon L M van Hooff, Debby G J Beckers, Wendela E Hooftman, Michiel A J Kompier, Sabine A E Geurts
OBJECTIVES: This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty) and employees' experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call duties, on-call work demands, and satisfaction with compensation for on-call duties) on the one hand and fatigue, strain-based and time-based work-home interference (WHI), and perceived on-call performance difficulties (PPD) on the other hand...
2015: BioMed Research International
Amanda Kohlbrenner, Rachel Dirks, James Davis, Mary Wolfe, Christina Maser
BACKGROUND: Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education. METHODS: A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation...
June 2016: American Journal of Surgery
Meghana R K Helder, Phillip G Rowse, Raaj K Ruparel, Zhuo Li, David R Farley, Lyle D Joyce, John M Stulak
BACKGROUND: Current resident and student duty-hour restrictions necessitate efficient training, which may be aided by simulation. Data on the utility of low-cost simulation in cardiothoracic surgery are scant. We evaluated the effect and value of a low-cost, low-fidelity aortic anastomosis simulation curriculum. METHODS: Twenty participants (11 medical students, 9 residents) completed an aortic anastomosis on a porcine heart as a pretest. Participants were then provided access to a 14-minute online video created by a cardiac surgeon and given a low-cost task trainer for self-directed practice...
January 2016: Annals of Thoracic Surgery
Ning-Zi Sun, Runye Gan, Linda Snell, Diana Dolmans
PURPOSE: Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. METHOD: In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system...
March 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Robert W Bina, G Michael Lemole, Travis M Dumont
Within neurosurgery, the national mandate of the 2003 duty hour restrictions (DHR) by the Accreditation Council for Graduate Medical Education (ACGME) has been controversial. Ensuring the proper education and psychological well-being of residents while fulfilling the primary purpose of patient care has generated much debate. Most medical disciplines have developed strategies that address service needs while meeting educational goals. Additionally, there are numerous studies from those disciplines; however, they are not specifically relevant to the needs of a neurosurgical residency...
March 2016: Journal of Neurosurgery
Jessica R Golbus, David A Manly, Katherine A Wonneberger, Thomas C Hanff, Kathleen M Murphy, Daniel S Wang, Steven G McKee, Lisa Bellini
BACKGROUND: Duty hour restrictions for resident physicians have led to radical changes in graduate medical education, including a shift to more night float rotations. These rotations have been viewed by residents as predominantly service focused with little opportunity for formalized education. OBJECTIVE: To develop and deliver a resident-driven, nocturnal curriculum to enhance the educational content and value of night float rotations. METHODS: The Hospital of the University of Pennsylvania is a 695-bed, tertiary care academic medical center...
September 2015: Journal of Graduate Medical Education
Michael P Smrtka, Ravindu P Gunatilake, Benjamin Harris, Miao Yu, Lan Lan, Leo R Brancazio, Fidel A Valea, Chad A Grotegut, Haywood L Brown
BACKGROUND: In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. OBJECTIVE: We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. METHODS: We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011...
September 2015: Journal of Graduate Medical Education
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