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Accuracy of residents' retrospective perceptions of 16-hour call admitting shift compliance and characteristics.

ABSTRACT: BACKGROUND: The Accreditation Council for Graduate Medical Education Resident-Fellow Survey measurement of compliance with duty hours uses remote retrospective resident report, the accuracy of which has not been studied. We investigated residents' remote recall of 16-hour call-shift compliance and workload characteristics at 1 institution. METHODS: We sent daily surveys to second- and third-year internal medicine residents immediately after call shifts from July 2011 to June 2012 to assess compliance with 16-hour shift length and workload characteristics. In June 2012, we sent a survey with identical items to assess residents' retrospective perceptions of their call-shift compliance and workload characteristics over the preceding year. We used linear models to compare on-call data to residents' retrospective data. RESULTS: We received a survey response from residents after 497 of 648 call-shifts (77% response). The end-of-year perceptions survey was completed by 87 of 95 residents (92%). Compared with on-call data, the recollections of 5 (6%) residents were accurate; however, 48 (56%) underestimated and 33 (38%) overestimated compliance with the 16-hour shift length requirement. The average magnitude of under- and overestimation was 18% (95% confidence interval = 13-23). Using a greater than 10% absolute difference to define under- and overestimation, 39 (45%) respondents were found to be accurate, 27 (31%) underestimated compliance, and 20 (23%) overestimated compliance. Residents overestimated census size, long call admissions, and admissions after 5 pm. CONCLUSIONS: Internal medicine residents' remote retrospective reporting of compliance with the 16-hour limit on continuous duty and workload characteristics was inaccurate compared with their immediate recall and included errors of underestimation and overestimation.

SUBMITTER: Gonzalo JD

PROVIDER: S-EPMC3886463 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundThe Accreditation Council for Graduate Medical Education duty hour requirements may affect residents' understanding and practice of professionalism.ObjectiveWe explored residents' perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements.DesignAnonymous cross-sectional survey.ParticipantsInternal medicine, neurology, and family practice residents at 3 teaching hospitals (n=312).MeasurementsUsing Likert scales and open-ended questions, the questionnaire explored the following: residents' attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism.ResultsOne hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing professionalism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork.ConclusionsResidents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.

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Accuracy of residents' retrospective perceptions of 16-hour call admitting shift compliance and characteristics.

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