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https://www.readbyqxmd.com/read/28720087/resident-perceptions-of-the-impact-of-duty-hour-restrictions-on-resident-attending-interactions-an-exploratory-study
#1
Kristen A Gerjevic, Marcy E Rosenbaum, Manish Suneja
BACKGROUND: The institution of duty hour reforms by the Accreditation Council for Graduate Medical Education in 2003 has created a learning environment where residents are consistently looking for input from attending physicians with regards to balancing duty hour regulations and providing quality patient care. There is a paucity of literature regarding resident perceptions of attending physician actions or attitudes towards work hour restrictions. The purpose of this study was to identify attending physician behaviors that residents perceived as supportive or unsupportive of their compliance with duty hour regulations...
July 18, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28697744/e-learning-in-graduate-medical-education-survey-of-residency-program-directors
#2
Christopher M Wittich, Anoop Agrawal, David A Cook, Andrew J Halvorsen, Jayawant N Mandrekar, Saima Chaudhry, Denise M Dupras, Amy S Oxentenko, Thomas J Beckman
BACKGROUND: E-learning-the use of Internet technologies to enhance knowledge and performance-has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics. METHODS: We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs...
July 11, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28638506/efficacy-of-interventions-to-reduce-resident-physician-burnout-a-systematic-review
#3
REVIEW
Kiran R Busireddy, Jonathan A Miller, Kathleen Ellison, Vicky Ren, Rehan Qayyum, Mukta Panda
BACKGROUND: Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it. OBJECTIVE: This systematic literature review explores the efficacy of interventions in reducing resident burnout. METHODS: PubMed, Embase, and Web of Science were searched using these key words: burnout and resident, intern, or residency. We excluded review articles, editorials, letters, and non-English-language articles...
June 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28570718/free-flap-reconstruction-monitoring-techniques-and-frequency-in-the-era-of-restricted-resident-work-hours
#4
Urjeet A Patel, David Hernandez, Yelizaveta Shnayder, Mark K Wax, Matthew M Hanasono, Joshua Hornig, Tamer A Ghanem, Matthew Old, Ryan S Jackson, Levi G Ledgerwood, Patrik Pipkorn, Lawrence Lin, Adrian Ong, Joshua B Greene, James Bekeny, Yin Yiu, Salem Noureldine, David X Li, Joel Fontanarosa, Evan Greenbaum, Jeremy M Richmon
Importance: Free flap reconstruction of the head and neck is routinely performed with success rates around 94% to 99% at most institutions. Despite experience and meticulous technique, there is a small but recognized risk of partial or total flap loss in the postoperative setting. Historically, most microvascular surgeons involve resident house staff in flap monitoring protocols, and programs relied heavily on in-house resident physicians to assure timely intervention for compromised flaps...
June 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28550926/restrictions-on-surgical-resident-shift-length-does-not-impact-type-of-medical-errors
#5
Jamie E Anderson, Laura F Goodman, Guy W Jensen, Edgardo S Salcedo, Joseph M Galante
BACKGROUND: In 2011, resident duty hours were restricted in an attempt to improve patient safety and resident education. With the goal of reducing fatigue, shorter shift length leads to more patient handoffs, raising concerns about adverse effects on patient safety. This study seeks to determine whether differences in duty-hour restrictions influence types of errors made by residents. MATERIALS AND METHODS: This is a nested retrospective cohort study at a surgery department in an academic medical center...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28439356/impact-of-the-2003-acgme-resident-duty-hour-reform-on-hospital-acquired-conditions-a-national-retrospective-analysis
#6
Timothy Wen, Frank J Attenello, Steven Y Cen, Alexander A Khalessi, May Kim-Tenser, Nerses Sanossian, Steven L Giannotta, Arun P Amar, William J Mack
BACKGROUND: The Accreditation Council for Graduate Medical Education reforms in 2003 instituted an 80-hour weekly limit for resident physicians. Critics argue that these restrictions have increased handoffs among residents and the potential for a decline in patient safety. "Never events" hospital-acquired conditions (HACs) are a set of preventable events used as a quality metric in hospital safety analyses. OBJECTIVE: This analysis evaluated post-work hour reform effects on HAC incidence for US hospital inpatients, using the National Inpatient Sample...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28398961/accreditation-council-for-graduate-medical-education-acgme-surgery-resident-operative-logs-the-last-quarter-century
#7
COMPARATIVE STUDY
Frederick Thurston Drake, Shahram Aarabi, Brandon T Garland, Ciara R Huntington, Jarod P McAteer, Morgan K Richards, Nicole Kansier Zern, Kenneth W Gow
STUDY OBJECTIVE: To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. BACKGROUND: Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room...
May 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28329124/sleep-and-alertness-in-medical-interns-and-residents-an-observational-study-on-the-role-of-extended-shifts
#8
Mathias Basner, David F Dinges, Judy A Shea, Dylan S Small, Jingsan Zhu, Laurie Norton, Adrian J Ecker, Cristina Novak, Lisa M Bellini, Kevin G Volpp
Study Objectives: Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Methods: Sleep-wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy...
April 1, 2017: Sleep
https://www.readbyqxmd.com/read/28327274/physician-extenders-on-surgical-services-a%C3%A2-systematic-review
#9
REVIEW
Jagdeep Johal, Andrew Dodd
BACKGROUND: With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. METHODS: We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials...
June 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28261407/factors-influencing-residency-program-selection-by-medical-students-pursuing-obstetrics-and-gynecology
#10
Meredith J Alston, Torri D Metz, Russell Fothergill, Amy Meg Autry, Sarah A Wagner, Amanda A Allshouse, Alyssa Stephenson-Famy
BACKGROUND : Little is known about the factors that influence medical student selection of obstetrics and gynecology (ob-gyn) residency programs. OBJECTIVE : We assessed the factors influencing residency program selection by fourth-year medical students pursuing ob-gyn training. METHODS : A voluntary, anonymous, 19-question survey of residency selection factors was distributed to all fourth-year medical students interviewing at 1 of 5 academic ob-gyn departments for a residency position during the 2013-2014 interview season...
February 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28212590/the-july-effect-on-maternal-peripartum-complications-before-and-after-resident-duty-hour-reform-a-population-based-retrospective-cohort-study
#11
Ithan D Peltan, Crystal E Brown, Alson K Burke, Eric J Chow, Ali Rowhani-Rahbar, Matthew R Crull
Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the "July effect." Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003...
July 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28196195/association-of-otolaryngology-resident-duty-hour-restrictions-with-procedure-specific-outcomes-in-head-and-neck-endocrine-surgery
#12
Aaron Smith, Lauren Braden, Jim Wan, Merry Sebelik
Importance: Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. Objective: To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Design, Setting, and Participants: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS)...
June 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28186478/meaningful-use-an-electronic-medical-record-tool-for-cerebrospinal-fluid-shunt-history
#13
Lance S Governale, Jeffrey M Hoffman
The care of patients with shunted hydrocephalus can be complicated. The best assessment is provided when all data are available to the neurosurgery practitioner. However, data can be time-consuming to gather, especially in the setting of a busy practice, a trainee environment with duty-hour restrictions, and an electronic medical record (EMR) not specifically designed for the needs of subspecialists. For these reasons, the complete clinical picture, especially the historical component, is sometimes not assembled...
April 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28118548/the-nasal-fracture-algorithm-a-case-for-protocol-driven-management-to-optimize-care-and-resident-work-hours
#14
Alexander Lanigan, Joshua Lospinoso, Sarah N Bowe, Adrienne M Laury
Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed...
January 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28000231/duty-hour-restrictions-and-surgical-complications-for-head-and-neck-key-indicator-procedures
#15
Aaron Smith, Nikhita Jain, Jim Wan, Lei Wang, Merry Sebelik
OBJECTIVES/HYPOTHESIS: Graduate medical education has traditionally required long work hours, allowing trainees little time for adequate rest. Based on concerns over performance deterioration with sleep deprivation and its effect on patient outcomes, duty hour restrictions have been mandated. We sought to characterize complications from otolaryngology key indicator procedures performed before and after duty hour reform. STUDY DESIGN: Retrospective cross-sectional analysis of National Inpatient Sample (NIS)...
December 21, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27973648/complementing-operating-room-teaching-with-video-based-coaching
#16
Yue-Yung Hu, Laura M Mazer, Steven J Yule, Alexander F Arriaga, Caprice C Greenberg, Stuart R Lipsitz, Atul A Gawande, Douglas S Smink
Importance: Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience. Objective: To develop and evaluate a postoperative video-based coaching intervention for residents. Design, Setting, and Participants: In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital...
April 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/27969561/development-of-a-night-float-call-model-for-obstetrics-and-gynaecology-residency-the-process-and-residents-perceptions
#17
Lynn Sterling, Carmen McCaffrey, Michael Secter, Rebecca Rich, Jessica Green, Lindsay Shirreff, Donna Steele
The 2013 pan-Canadian consensus Report on Resident Duty Hours identified that traditional 24-hour duty periods pose risks to the well-being of residents and should be avoided. In anticipation of duty-hour restrictions, the Obstetrics and Gynaecology Residency Program at the University of Toronto developed and implemented a night float (NF) call model over a three-year span. Quarterly resident surveys have consistently shown that the NF system is preferred to traditional 24-hour call and has resulted in reduced fatigue and improved continuity of patient care...
November 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27965068/pda-based-self-work-sampling-study-of-pediatric-interns-quantifies-workday-and-educational-value
#18
Joyce K Campbell, Michael V Ortiz, Mary C Ottolini, Sarah Birch, Dewesh Agrawal
OBJECTIVE: Optimizing clinical proficiency and education of residents has become more important with restricted residency duty hours. Our objective was to investigate how interns spend their time on inpatient rotations and the perceived educational value of workday activities. METHODS: A descriptive, self-work sampling study using a personal digital assistant (PDA) to randomly query interns on inpatient rotations in real time as to their activity and the perceived educational value of that activity on a 4-point Likert scale...
December 10, 2016: Academic Pediatrics
https://www.readbyqxmd.com/read/27938726/-the-remains-of-the-day-a-working-day-in-a-university-children-s-hospital
#19
Florian Heinen, Mirjam N Landgraf, Jens Böhmer, Ingo Borggräfe, Christoph Bidlingmaier, Katrin Krohn, Florian Hoffmann, Thomas Nicolai, Matthias Weigl, Rüdiger von Kries, Lucia Albers
BACKGROUND: Limited time available for direct patient contact and a lot of time required for administrative duties have been reported by physicians working in adult medicine. OBJECTIVE: To characterize the typical daily work routine in a major pediatric university hospital. MATERIALS AND METHODS: A self-administered questionnaire was completed by physicians in the University Children's Hospital, Munich. The questionnaire captured the time spent on direct patient contact and on administrative tasks as well as the physicians' clinical experience and the location where the respective work was actually carried out (inpatient ward, outpatient emergency department, specialized outpatient clinic or department for developmental medicine)...
November 2016: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/27923090/association-between-end-of-rotation-resident-transition-in-care-and-mortality-among-hospitalized-patients
#20
Joshua L Denson, Ashley Jensen, Harry S Saag, Binhuan Wang, Yixin Fang, Leora I Horwitz, Laura Evans, Scott E Sherman
Importance: Shift-to-shift transitions in care among house staff are associated with adverse events. However, the association between end-of-rotation transition (in which care of the patient is transferred) and adverse events is uncertain. Objective: To examine the association of end-of-rotation house staff transitions with mortality among hospitalized patients. Design, Setting, and Participants: Retrospective multicenter cohort study of patients admitted to internal medicine services (N = 230 701) at 10 university-affiliated US Veterans Health Administration hospitals (2008-2014)...
December 6, 2016: JAMA: the Journal of the American Medical Association
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