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Resident perceptions of the impact of work hour limitations.

ABSTRACT: BACKGROUND: Mandatory work hour limitations for residents began in July 2003. There has been little evaluation of the impact of the new limitations on Internal Medicine residency training. OBJECTIVE: To assess Internal Medicine residents' perceptions of the impact of work hour limitations on clinical experiences, patient care, resident education, and well-being, and their compliance with the limitations. DESIGN AND PARTICIPANTS: Cross-sectional survey administered to Internal Medicine residents at 1 large U.S. teaching hospital. MEASUREMENTS: Resident perceptions using 5-point Likert scales, and self-reported compliance. Exploratory factor analysis was used to identify underlying domains and develop scales. RESULTS: The survey response rate was 85%. Five domains were identified by factor analysis: 1) clinical experience, 2) patient care and safety, 3) communication, 4) satisfaction with training, and 5) work-rest balance. Residents perceived work hour limitations to have a negative impact on clinical experience (mean scale score 1.84, 1 = negative, 5 = positive), patient care and safety (2.64), and communication domains (1.98). Effects on satisfaction (3.12) and work-rest balance domains (2.95) were more positive. Senior residents perceived more negative effects of work hour limitations than interns. Compliance was difficult; 94% interns and 70% residents reported violating work hour limits. Patient care and teaching duties were the main reasons for work hour violations. CONCLUSIONS: This study suggests that the current work hour limitations may be having unintended negative consequences on residency training. Ongoing monitoring to evaluate the impact of program changes as a result of work hour regulation is crucial to improving residency training.

SUBMITTER: Lin GA

PROVIDER: S-EPMC2219723 | biostudies-other | 2007 Jul

REPOSITORIES: biostudies-other

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Project description:IntroductionMeasuring staff perceptions with safety climate surveys is a promising approach to addressing patient safety. Variation in safety climate scores between work sites may predict variability in risk related to tasks, work environment, staff behavior, and patient outcomes. Safety climate measurements may identify considerable variation in staff perceptions across work sites.ObjectiveTo explore variation in staff perceptions of patient safety climate across work sites in Norwegian General Practitioner (GP) practices and Out-of-hours clinics.MethodsThe Norwegian Safety Attitudes QuestionnaireAmbulatory Version (SAQ A) was used to survey staff perceptions of patient safety climate across a sample of GP practices and Out-of-hours clinics in Norway. We invited 510 primary health care providers to fill out the questionnaire anonymously online in October and November 2012. Work sites were 17 regular GP practices in Sogn & Fjordane County, and seven Out-of-hours clinics, of which six were designated as "Watchtower Clinics". Intra-class correlation coefficients were calculated to identify what proportion of the variation in the five factor scores (Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions) were at work site-level.ResultsOf the 510 invited health care providers, 266 (52%) answered the questionnaire. Staff perceptions varied considerably at the work site level: intra-class correlation coefficients (ICCs) were 12.3% or higher for all factors except for Job satisfaction-the highest ICC value was for Perceptions of management: 15.5%.ConclusionAlthough most of the score variation was at the individual level, there was considerable response clustering within the GP practices and OOH clinics. This implies that the Norwegian SAQ A is able to identify GP practices and OOH clinics with high and low patient safety climate scores. Patient safety climate scores produced by the Norwegian version of the SAQ A may, thus, guide improvement and learning efforts to work sites according to the level of their scores.

Project description:ContextThe ACGME-released revisions to the 2003 duty hour standards.ObjectiveTo review the impact of the 2003 duty hour reform as it pertains to resident and patient outcomes.Data sourcesMedline (1989-May 2010), Embase (1989-June 2010), bibliographies, pertinent reviews, and meeting abstracts.Study selectionWe included studies examining the relationship between the pre- and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies.Data extractionOne rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality.ResultsOf 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Meta-analysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I(2) 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies.LimitationsMost studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible.ConclusionsSince 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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Resident perceptions of the impact of work hour limitations.

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