scholarly journals Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011 ◽  
Vol 26 (8) ◽  
pp. 907-919 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Darcy A. Reed ◽  
Vineet M. Arora
Keyword(s):  
Patient Safety ◽  
Resident Education ◽  
Well Being

scholarly journals Resident Duty Hours: A Review

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Lindsay Melvin ◽  
Sophie Corriveau ◽  
Aiman Alak ◽  
Ameen Patel
Keyword(s):  
Patient Safety ◽  
Resident Education ◽  
Well Being ◽  
The United States ◽  
Complex Issue ◽  
Duty Hours ◽  
Fatigue Management ◽  
Controversial Topic ◽  
Resident Duty ◽  
Work Up

Residents are physicians undertaking further training to become independently licensed practitioners. Historically, resident duty hour periods were long and intense. The goal was to maximize learning through high patient volume and to teach doctors how to take responsibility. Recently, concerns over patient and resident safety have led to restricted trainee work hours. The putative justification is to improve resident education, resident well-being, and patient care. In light of this recent shift in the medical culture, resident duty hours have become a controversial topic. Restricted duty hours take many forms. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) mandated junior residents work no longer than 16 consecutive hours, while senior residents could work up to 26 hours.1 In Canada, no nationwide mandate exists and the issue falls within provincial jurisdiction. In Ontario, under the Professional Association of Residents of Ontario agreement, call-periods are no more than 26 consecutive hours in-house, no more than one in four nights in-house, or no more than one in three nights of home-call. After a 2011 Quebec court ruling, resident duty hours were restricted to 16 consecutive hours in that province. This resulted from the court concluding that traditional hours violate the Canadian Charter of Rights and Freedoms. Regardless, the Quebec ruling prompted other Canadian programs to further reduce resident duty hours and consecutive hours on-call. To better understand this complex issue, the following review discusses resident safety, resident performance, resident education, and patient safety. Our goal is to present a balanced, evidence-based discussion, addressing both patient safety and resident fatigue management.

scholarly journals The Effect of Residents Working-Hour Restrictions on Patient Safety, Resident Well-Being, and Resident Education: Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Gabriela Zavala Wong ◽  
Maitza R Vidal Meza ◽  
Maria Lazo-Porras
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Resident Education ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Working Hours ◽  
Well Being ◽  
Safety Parameters ◽  
The Impact ◽  
Working Hour

Introduction: Residents duty hour restrictions have been a source of debate throughout the years, given that extended shifts have historically been associated with a negative effect on patient safety. Implementing restricted duty hours may help reduce sleep deprivation and workload, consequently improving residents sense of well-being. On the other hand, these reforms implicate a greater number of handoffs where communication errors may arise, and continuity of care being lost as a result. In a similar way, shorter shifts may implicate less time of direct patient contact and, consequently, decreased educational opportunities for residents. Various studies have attempted to explore the effect of resident work hour reforms on patient safety outcomes. However, these have been mainly based solely on observational studies that have not been subjected to the same rigor as experimental ones, primarily because no randomized controlled trials (RCT) were available in this matter. Nonetheless, more substantial evidence has become available in these last few years as three RCTs have been published exploring the impact of resident duty hour restrictions on patient safety as well as on residents wellbeing and education. An updated systematic review and meta-analysis are crucial to interpret this data that has now become available. Objectives: To evaluate the effect of resident physicians working-hour restrictions on patient safety parameters, residents perceived well-being and resident education. Methods and analysis: This research protocol was developed according to PRISMA-P and the Cochrane guidelines for systematic reviews and metanalysis. Electronic literature search strategies were developed using MeSH and free terms to be carried out in PubMed, MEDLINE, EMBASE, Cochrane Library, Clinicaltrials.gov and Global Index Medicus with no restriction in language. Primary outcome measures include several patient safety parameters, whereas secondary outcome measures involve resident well-being and education. Two research team members will screen identified titles, abstract and full text, evaluate risk of bias and extract data in an independent manner. A qualitative narrative synthesis will be employed to summarize the key findings, population, and methodology of studies using text and tables for both primary and secondary outcomes. We will test for heterogeneity of the included studies by employing the I2 statistical test; if significant (I2 > 75%), only qualitative synthesis will be presented. On the contrary, if studies are homogeneous, a meta-analysis will be considered using Review Manager 5.1 software. For continuous data, we will calculate the mean difference or standardized mean difference. For dichotomous data, the risk ratio (RR) will be calculated. Results will be displayed on a Forest Plot. To assess bias, a Funnel plot and Egger test will be employed. Conclusions: This systematic review will provide evidence regarding the effect of resident physicians working-hour restrictions on patient safety parameters, residents perceived well-being and resident education. All of these are variables that must be considered when determining policies regarding the medical training environment. It is essential to review the existing high-grade evidence regarding the impact of residents extended working hours so that authorities can optimize future graduate medical education regulations. Keywords: resident working hours, patient safety, resident well-being, resident education Conflicts of interest: No conflicts of interest declared by any of the authors. Funding: There is no public or private institution funding this project.

scholarly journals Patient safety may be compromised if study conclusions are generalized to products that make similar claims but have no equivalent research evidence

2018 ◽  
Vol 24 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Amit Gefen ◽  
Nick Santamaria ◽  
Sue Creehan ◽  
Joyce Black
Keyword(s):  
Patient Safety ◽  
Medical Device ◽  
Cost Benefit ◽  
Well Being ◽  
Product Selection ◽  
Specific Product ◽  
Medical Claims ◽  
Published Evidence ◽  
Pressure Injury ◽  
Pressure Injury Prevention

This paper addresses a fundamentally important issue in health care, namely how to make informed decisions on product selection when two products, from different manufacturers, appear to be similar and have medical claims that sound comparable. In such cases, manufacturers of competing products often use each other’s evidence. They argue that the published evidence is generally applicable even if the original bioengineering tests and clinical trials were performed on a specific product, and no equivalence was obtained for their product that has similar medical claims. In this work, we use prophylactic dressings for pressure injury prevention as a good demonstrative example on how patient safety may be compromised if study conclusions are generally projected to such unstudied products. The medical device industry is regulated differently than the pharmaceutical industry, and consequently, voids in current medical device regulation are sometimes used to promote commercial interests. This paper analyzes gaps and potential pitfalls that occur where guiding documentations (e.g. guidelines, standards) do not cope well with medical technology. We explain how that can eventually lead to potential compromises to the well-being of patients, primarily if nurses are unaware of the aforementioned pitfalls. We conclude that currently, there is no alternative to rigorousness: Clinicians and decision-makers need to scrutinize up-to-date literature, decide which products have the best portfolio of bioengineering and clinical research to support the claims made, and which products have the best cost–benefit models. This is fundamentally different from simply buying the least expensive product because of appealing sale arguments.

Insights on Otolaryngology Residency Training during the COVID-19 Pandemic

2020 ◽  
Vol 163 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Dana L. Crosby ◽  
Arun Sharma
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Learning Strategies ◽  
Residency Training ◽  
Resident Education ◽  
Training Programs ◽  
Well Being ◽  
Office Visits ◽  
Key Indicator ◽  
Medical Crisis ◽  
The Impact

Otolaryngology residency training programs are facing a novel challenge due to severe acute respiratory syndrome coronavirus 2. The widespread impact and chronicity of this pandemic makes it unique from any crisis faced by our training programs to date. This international medical crisis has the potential to significantly alter the course of training for our current resident cohort. The decrease in clinical opportunities due to the limitations on elective surgical cases and office visits as well as potential resident redeployment could lead to a decline in overall experience as well as key indicator cases. It is important that we closely monitor the impact of this pandemic on resident education and ensure the implementation of alternative learning strategies while maintaining an emphasis on safety and well-being.

scholarly journals What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles

2016 ◽  
Vol 8 (5) ◽  
pp. 795-805 ◽  
Author(s):  
Ingrid Philibert
Keyword(s):  
Patient Safety ◽  
Scientific Literature ◽  
Well Being ◽  
Work Hours ◽  
Small Samples ◽  
Empirical Literature ◽  
Future Research ◽  
Resident Work ◽  
Work Hour ◽  
The Impact

ABSTRACT Background  Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. Objective  A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours—including patient safety, learning, and resident well-being. Methods  Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. Results  Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. Conclusions  The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.

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