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PubMed1991

House staff work hours and moonlighting: what do residents want? A survey of pediatric residents in California.

In the autumn of 1988, pediatric residents were surveyed on attitudes toward work hours, moonlighting, and priorities in regulation of working conditions. Questionnaires for all 756 California residents in accredited pediatric programs were sent to chief residents. Of these, 676 questionnaires were distributed to residents and 319 (47%) were returned. Respondents indicated strong support for limits on house staff working hours, and most approved of the reduction regulations proposed in New York State. Most believed that individual departments, hospitals, or subspecialties should regulate hours. By a ratio of 4.3:1, however, respondents favored legislative intervention if such limits were not set by the profession. Moonlighting was generally considered to be an individual's choice and responsibility, but a majority were willing to restrict moonlighting if total house staff hours were also limited.

Attitude of Health Personnel↗
PubMed1992

A faculty-house staff retreat.

There has been much discussion regarding the causes of stress in residency training programs and solutions to alleviate the pressure. As a partial solution, we have found discussions of retreats for pediatric interns in the medical literature, but no discussion of department-wide retreats. Since the early 1970s, the University of Wisconsin (Madison) Department of Pediatrics has held a faculty-house staff retreat every 2 years. The more recent retreats used process-oriented discussions in its goals of fostering understanding through group communication to reduce stress. The 1989 agenda was an expansion of previous efforts with extensive faculty and house staff involvement before, during, and after the retreat. The purposes of this article are to review the literature on the use of retreats in various settings, especially residency training programs; describe the past and present use of retreats by the University of Wisconsin Department of Pediatrics; describe the 1989 retreat; and describe the positive and negative aspects relating to retreats as we have used them. We believe our retreat is unique, serves many purposes, and has been a successful tool for relieving residency stress.

Counseling↗
PubMed1993

Black clouds. Work load, sleep, and resident reputation.

OBJECTIVE: Although it is assumed that residents in a specific training program will have comparable experiences, residents commonly perceive that some have consistently more difficult times on call. Such residents in our program are said to have "black clouds." We sought to determine if these perceptions were related to differences in real work load. METHODS: We collected data about the on-call experiences of our first-year pediatric residents (PL-1s) for 358 days (1355 on-call experiences) during the 1984-1985 academic year. Every PL-1 (n = 19) reported the following data the morning after each night on call: hours of sleep, number of admissions, total number of patients, number of deaths, number of transfers to the pediatric intensive care unit, number of delivery room trips, and a subjective assessment of work load, using a three-point scale. The reputation of each house officer was determined by asking all residents in the program (PL-1s, PL-2s, and PL-3s) to rate each other three times during the year regarding how hard they worked on call. RESULTS: There were significant differences among PL-1s in how difficult they perceived their work load to be and in how much they slept (P < .001 using analysis of variance). However, actual work load (as measured by the number of either admissions or patients) did not vary significantly among the residents. There was a strong negative association between self-perception of work load and hours of sleep (r = -.75; 95% confidence interval, -0.73 to -0.76). Sleep was the major predictor of perceived work load (multiple R2 = .563 using multiple linear regression analysis). The absence of an association between perceived and actual work load is attributed to large differences in the residents' working styles. This is evidenced by a wide range of correlations among PL-1s between the number of admissions and hours of sleep (range of r values, -.66 to -.16). A reputation for difficult on-call experiences was strongly associated with few hours of sleep (r = -.77; 95% confidence interval, -0.49 to -0.91), but not with actual work load measured by the number of admissions, patients, deaths, or other variables. Sleep was the major predictor of reputation (multiple R2 = .567 using multiple linear regression analysis). CONCLUSIONS: Some residents did have a black cloud; they slept less, perceived that they worked harder than average, and had a reputation for having difficult on-call experiences. Residents with a black cloud function differently from their colleagues; for example, some may be inefficient, while others may create extra work for themselves. Residency program directors must recognize these functional differences to effectively evaluate and counsel house officers.

Analysis of Variance↗
PubMed2003

A survey of residents and faculty regarding work hour limitations in surgical training programs.

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions. SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: All voluntarily participating surgical faculty and residents. MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment. METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis. RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery. CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.

Adult↗
PubMed2003

Physician assistant influence on surgery residents.

HYPOTHESIS: We hypothesized that physician assistants (PAs) will decrease surgery resident work hours and improve resident work outlook. DESIGN: Surgical resident survey. SETTING: A county hospital in a university-based surgical residency program. PARTICIPANTS: Surgery residents who switched (or "rotated") to the county hospital were polled monthly for 6 months after using PAs as team members on the surgical services. MAIN OUTCOME MEASURES: Resident work hours and work outlook. RESULTS: Surgery resident hours were significantly decreased by the fourth, fifth, and sixth months after PAs joined the surgical services. Despite what these data on resident hours suggest, 6 (60%) of 10 residents believed that the PAs had no influence on the amount of time the residents spend in the hospital. Six (60%) of 10 residents thought the PAs decreased stress levels and 6 (60%) of 10 residents thought the PAs helped to improve morale. CONCLUSIONS: Physician assistants can have a positive influence on graduate surgical education programs. Physician assistants can help decrease surgery resident work hours and improve resident work outlook.

Attitude of Health Personnel↗
PubMed2004

Effect of the 80-hour workweek on resident burnout.

HYPOTHESIS: With the introduction of the newly mandated restrictions on resident work hours, we expected improvement in subjective feelings of personal accomplishment and lessened emotional exhaustion and depersonalization. DESIGN: Residents and faculty members completed an anonymous online Maslach Burnout Inventory Human Services Survey (3rd ed; Consulting Psychologist Press Inc, Palo Alto, Calif) and work-hour registry before and after implementation of new restrictions. SETTING: Urban, university-based department of surgery. PARTICIPANTS: All house staff (n = 37) and faculty (n = 27). INTERVENTION: Introduction of new Institutional Standards for Resident Duty Hours 2003. Main Outcome Measure Resident work hours and levels of emotional exhaustion, perceived degree of depersonalization, and personal accomplishment. RESULTS: Resident work hours per week decreased from 100.7 to 82.6 (P < .05) with introduction of the new schedule. Home call and formal educational activity time within working hours (eg, clinical conferences) significantly (P < .05) decreased from 11.5 and 4.8 hours to 4.6 and 2.5 hours per week, respectively. Operating room hours, clinic time, and duration of rounds did not show a significant change. Changes in parameters of resident and faculty emotional exhaustion, depersonalization, and personal accomplishment did not show statistical significance (P > .05). CONCLUSIONS: Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced.

Burnout, Professional↗
PubMed1990

Survey of residents' attitudes toward reform of work hours.

Traditional work schedules of surgical residents have been cited as a factor that negatively influences residency education and the quality of patient care. As an adjunct to the formulation of recommendations for the development of the environment for general surgery training, the New England Association of Program Directors in Surgery set out to sample the attitudes of surgical residents in New England relative to their perceived need to reform work hours. Seventy-two percent of the residents thought there was a need for some level of resident work schedule change. The major variable that correlated with this opinion was the reported amount of sleep that a resident needed before returning to work after a 24-hour shift. The ultimate effect on education, patient care, and fiscal resources of these potentially sensitive changes remains to be determined.

Adult↗
PubMed1995

Surgical residents in the 1990s. Issues and concerns for men and women.

OBJECTIVE: To survey the concerns of surgical residents in New England and to determine whether similarities or differences exist based on gender. DESIGN/SETTING: A survey was distributed to all 21 surgical residency programs. The survey consisted of six demographic questions and 23 items, which the residents coded on a Likert-type scale. PARTICIPANTS: Surgical residents enrolled in a general surgical residency or specialty residents completing general surgery requirements. INTERVENTION: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Prominent concerns among residents during training years and gender differences based on these concerns. RESULTS: All programs responded. A completed survey was returned by 501 residents (73%), 378 (75%) of whom were male and 123 (25%) of whom were female. On a scale of 1 to 5 (from no concern to major concern), the five most important issues were work hours (mean, 3.4), personal finances (mean, 3.1), quantity and quality of formal education (mean, 3.0 each), and postponement of family plans (mean, 2.9). Six items surveyed were of more concern to women than men; availability of role models, mentors, or both; comfort in expressing emotions at work; initiating and maintaining personal relationships; having children during residency; and postponing family plans. CONCLUSIONS: Three of the highest-reported concerns for the entire group are issues that could conceivably be controlled by surgical chairpersons and program directors. In contrast, only one of the six concerns that differed for men and women is directly program related. The remaining five issues require changes in societal values for these differences to dissolve.

Adult↗