Impact of Duty Hour Regulations on Medical Students-Education: Views of Key Clinical Faculty

详细信息    查看全文

• 作者：Darcy A. Reed MD ; MPH (1)
  Rachel B. Levine MD ; MPH (2)
  Redonda G. Miller MD ; MBA (2)
  Bimal H. Ashar MD (2)
  Eric B. Bass MD ; MPH (2)
  Tasha Rice MS (2)
  Joseph Cofrancesco Jr. MD ; MPH (2)
  
• 关键词：medical students ; residents ; duty hours ; key clinical faculty ; internal medicine
• 刊名：Journal of General Internal Medicine
• 出版年：2008
• 出版时间：July 2008
• 年：2008
• 卷：23
• 期：7
• 页码：1084-1089
• 全文大小：201KB
• 参考文献：1. Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA. 2002;288(9)1112-. CrossRef
  2. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165222601-. CrossRef
  3. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165(22)2595-00. CrossRef
  4. Irani JL, Mello MM, Ashley SW, Whang EE, Zinner MJ, Breen E. Surgical residents-perceptions of the effects of the ACGME duty hour requirements 1?year after implementation. Surgery. 2005;138(2)246-3. CrossRef
  5. Fletcher KE, Underwood W III, Davis SQ, Mangrulkar RS, McMahon LF Jr., Saint S. Effects of work hour reduction on residents-lives: a systematic review. JAMA. 2005;294(9)1088-00. CrossRef
  6. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among patients in VA hospitals in the first 2?years following ACGME resident duty hour reform. JAMA. 2007;298:984-2. CrossRef
  7. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298:975-3. CrossRef
  8. Coverdill JE, Finlay W, Adrales GL, et al. Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study. Acad Med. 2006;81(1)50-6. CrossRef
  9. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006;243(6)864-1. CrossRef
  10. Reed DA, Levine RB, Miller RG, et al. Effect of residency duty-hour limits: views of key clinical faculty. Arch Intern Med. 2007;167(14)1487-2. CrossRef
  11. AAMC Medical School Graduation Questionnaire All Schools Report. Association of American Medical Colleges 2006. Available at: http://www.aamc.org/data/gq/allschoolsreports/2006.pdf. Accessed December 11, 2007.
  12. Chen J, Kamath R, Lam A, et al. How will changes in resident work hours affect medical students? Curr Surg. 2003;60:268-0. CrossRef
  13. Skeff KM, Ezeji-Okoye S, Pompei P, Rockson S. Benefits of resident work hours regulation. Ann Intern Med. 2004;140:816-.
  14. Liason Committee on Medical Education. Educational Program for the MD Degree. Available at: http://www.lcme.org/functionslist.htm#educational%20program. Accessed December 11, 2007.
  15. Brasher AE, Chowdhry S, Hauge LS, Prinz RA. Medical students-perceptions of resident teaching: have duty hours regulations had an impact? Ann Surg. 2005;242(4)548-3.
  16. White CB, Haftel HM, Purkiss JA, Schigelone AS, Hammoud MM. Multidimensional effects of the 80-hour work week at the University of Michigan Medical School. Acad Med. 2006;81(1)57-2. CrossRef
  17. Nixon LJ, Benson BJ, Rogers TB, Sick BT, Miller WJ. Effects of Accreditation Council for Graduate Medical Education work hour restrictions on medical student experience. J Gen Intern Med. 2007;22(7)937-1. CrossRef
  18. Jagsi R, Shapiro J, Weinstein DF. Perceived impact of resident work hour limitations on medical student clerkships: a survey study. Acad Med. 2005;80(8)752-. CrossRef
  19. Kogan JR, Bellini LM, Shea JA. The impact of resident duty hour reform in a medicine core clerkship. Acad Med. 2004;79(10 Suppl)S58-1. CrossRef
  20. Kogan JR, Pinto-Powell R, Brown LA, Hemmer P, Bellini LM, Peltier D. The impact of resident duty hours reform on the internal medicine core clerkship: results from the clerkship directors in internal medicine survey. Acad Med. 2006;81(12)1038-4. CrossRef
  21. Program Requirements for Residency Education in Internal Medicine. Available at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/140_im_07012007.pdf. Accessed December 11, 2007.
  22. NIH Awards to Medical Schools by Rank, Fiscal year 2004. Available at: http://grants.nih.gov/grants/award/rank/medttl04.htm. Accessed December 11, 2007.
  23. List of ACGME Accredited Programs and Sponsoring Institutions. Available at: http://www.acgme.org/adspublic/. Accessed December 11, 2007.
  24. Zar JH. Biostatistical analysis. 4th edn. Upper Saddle River, NJ: Prentice-Hall, Inc; 1999.
  25. Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44:1049-0. CrossRef
  26. AAMC US Medical School Faculty Reports, 2005. Available at: http://www.aamc.org/data/facultyroster/usmsf05/start.htm. Accessed December 11, 2007.
  27. Arora V, Wetterneck TB, Schnipper JL, et al. Effect of the inpatient general medicine rotation on student pursuit of a generalist career. J Gen Intern Med. 2006;21(5)471-. CrossRef
  28. Schwartz MD, Linzer M, Babbott D, Divine GW, Broadhead E. Medical student interest in internal medicine. Initial report of the society of general internal medicine interest group survey on factors influencing career choice in internal medicine. Ann Intern Med. 1991;114(1)6-5.
  29. McMurray JE, Schwartz MD, Genero NP, Linzer M. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Society of General Internal Medicine Task Force on Career Choice in Internal Medicine Ann Intern Med. 1993;119(8)812-.
  30. LCME. Functions and Structure of A Medical School, Standards for Accreditation of Medical Education Programs Leading to the MD Degree. http://www.lcme.org/functions2007jun.pdf. Accessed December 11, 2007.
  31. Arora VM, Seiden SC, Higa JT, Siddique J, Meltzer DO, Humphrey HJ. Effect of student duty hours policy on teaching and satisfaction of 3rd year medical students. Am J Med. 2006;119(12)1089-5. CrossRef
  32. Harrison R, Allen E. Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations. J Gen Intern Med. 2006;21(5)447-2. CrossRef
  33. Schuster B. Tough times for teaching faculty. Arch Intern Med. 2007;167(14)1453-. CrossRef
  34. Ogur B, Hirsh D, Krupat E, Bor D. The Harvard Medical School–Cambridge integrated clerkship: an innovative model of clinical education. Acad Med. 2007;82(4)397-04. (Apr). CrossRef
  35. Kellogg KC, Breen E, Ferzoco SJ, Zinner MJ, Ashley SW. Resistance to change in surgical residency: an ethnographic study of work hours reform. J Am Coll Surg. 2006;202(4)630-. CrossRef
  36. Nelson HD, Cooney TG, Kroenke K, Friedman RH. Contributions of general internal medicine teaching units: a national survey. J Gen Intern Med. 2000;15(5)277-3. CrossRef
  37. Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA. Interns-compliance with accreditation council for graduate medical education work-hour limits. JAMA. 2006;296(9)1063-0. CrossRef
  
• 作者单位：Darcy A. Reed MD, MPH (1)
  Rachel B. Levine MD, MPH (2)
  Redonda G. Miller MD, MBA (2)
  Bimal H. Ashar MD (2)
  Eric B. Bass MD, MPH (2)
  Tasha Rice MS (2)
  Joseph Cofrancesco Jr. MD, MPH (2)
  
  1. Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
  2. Johns Hopkins University School of Medicine, Baltimore, MD, USA
  

文摘

BACKGROUND Teaching faculty have valuable perspectives on the impact of residency duty hour regulations on medical students. OBJECTIVE The objective of this study was to elicit faculty views on the impact of residency duty hour regulations on medical students-educational experience on inpatient medicine rotations. DESIGN AND PARTICIPANTS We conducted a National Survey of Key Clinical Faculty (KCF) at 40 internal medicine residency programs affiliated with U.S. medical schools using a random sample stratified by National Institutes of Health funding and program size. MEASUREMENTS This study measures KCF opinions on the effect of duty hour regulations on students-education. RESULTS Of 154 KCF targeted, 111 responded (72%). Fifty-two percent of KCF reported worsening in the overall quality of students-education compared to just 2.7% reporting improvement (p-lt;-.001). In multivariate analysis adjusted for gender, academic rank, specialty, and years of teaching experience, faculty who spent ?5?hours per week teaching were more likely to report worsening in medical students-level of responsibility on inpatient teams [odds ratio (OR) 3.1; 95% confidence interval (CI) 1.3-.6], ability to follow patients throughout hospitalization (OR 3.2; 95% CI 1.3-.9), ability to develop working relationships with residents (OR 2.3; 95% CI 1.0-.2), and the overall quality of students-education (OR 3.3; 95% CI 1.4-.1) compared to faculty who spent less time teaching. CONCLUSION Key clincal faculty report concerns about the impact of duty hour regulations on aspects of medical students-education in internal medicine. Medical schools and residency programs should identify ways to ensure optimal educational experiences for students within duty hour requirements.