 |
|
CLINICIAN’S CORNER
Effects of Work Hour Reduction on Residents’ Lives
A Systematic Review
Kathlyn E. Fletcher, MD, MA;
Willie Underwood III, MD, MS, MPH;
Steven Q. Davis, MD;
Rajesh S. Mangrulkar, MD;
Laurence F. McMahon, Jr, MD, MPH;
Sanjay Saint, MD, MPH
JAMA. 2005;294:1088-1100.
Context The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents’ well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents.
Objective To summarize the literature regarding the effect of interventions to reduce resident work hours on residents’ education and quality of life.
Data Sources We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings.
Study Selection Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States.
Data Extraction For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form.
Data Synthesis Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents’ lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents’ quality of life. Many studies had major limitations in their design or conduct.
Conclusions Past interventions suggest that residents’ quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents’ quality of life and quality of patient care.
Author Affiliations: Department of Internal Medicine, Clement J. Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee (Dr Fletcher); Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich (Drs Underwood and Saint); Departments of Urology (Dr Underwood) and Internal Medicine (Drs Mangrulkar and McMahon), University of Michigan Medical School, Ann Arbor; Department of Internal Medicine, University of Chicago Pritzker School of Medicine, Chicago, Ill (Dr Davis).
RELATED ARTICLE
Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy
Drew Dawson and Phyllis Zee
JAMA. 2005;294(9):1104-1106.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Rates of medication errors among depressed and burnt out residents: prospective cohort study
Fahrenkopf et al.
BMJ 2008;336:488-491.
ABSTRACT
| FULL TEXT
Work patterns and fatigue-related risk among junior doctors
Gander et al.
Occup. Environ. Med. 2007;64:733-738.
ABSTRACT
| FULL TEXT
Improving Sleep Hygiene of Medical Interns: Can the Sleep, Alertness, and Fatigue Education in Residency Program Help?
Arora et al.
Arch Intern Med 2007;167:1738-1744.
ABSTRACT
| FULL TEXT
Trucks, Planes, and Scalpels: Is There an Evidence-Based Approach to Surgeons' Working Hours?
Leff et al.
Arch Surg 2007;142:817-820.
FULL TEXT
Effects of Resident Duty-Hours Restrictions on Surgical and Nonsurgical Teaching Faculty
Vanderveen et al.
Arch Surg 2007;142:759-766.
ABSTRACT
| FULL TEXT
Effect of Residency Duty-Hour Limits: Views of Key Clinical Faculty
Reed et al.
Arch Intern Med 2007;167:1487-1492.
ABSTRACT
| FULL TEXT
Changes in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations
Horwitz et al.
ANN INTERN MED 2007;147:97-103.
ABSTRACT
| FULL TEXT
Hippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients
Goldman and Fiebach
ANN INTERN MED 2007;147:143-144.
FULL TEXT
Sleep and Well-Being of ICU Housestaff
Parthasarathy et al.
Chest 2007;131:1685-1693.
ABSTRACT
| FULL TEXT
Assessment in Medical Education
Parakh et al.
NEJM 2007;356:2108-2110.
FULL TEXT
Pediatric Residency Duty Hours Before and After Limitations
Cull et al.
Pediatrics 2006;118:e1805-e1811.
ABSTRACT
| FULL TEXT
Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection.
Shojania et al.
ANN INTERN MED 2006;145:592-598.
ABSTRACT
| FULL TEXT
High-quality learning for high-quality health care: getting it right.
Leach and Philibert
JAMA 2006;296:1132-1134.
FULL TEXT
Redesigning Training for Internal Medicine
Weinberger et al.
ANN INTERN MED 2006;144:927-932.
ABSTRACT
| FULL TEXT
Naps and drugs to combat fatigue and sleepiness.
Guilleminault and Ramar
ANN INTERN MED 2006;144:856-857.
FULL TEXT
Residency Training in the Modern Era: The Pipe Dream of Less Time to Learn More, Care Better, and Be More Professional
O'Malley et al.
Arch Intern Med 2005;165:2561-2562.
FULL TEXT
The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program
Goitein et al.
Arch Intern Med 2005;165:2601-2606.
ABSTRACT
| FULL TEXT
Heavy Call Schedule Has Alcohol-Like Effect
Lamberg
Psychiatr. News 2005;40:17-17.
FULL TEXT
Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy
Dawson and Zee
JAMA 2005;294:1104-1106.
FULL TEXT
Medical Education 2005: From Allegory to Bull Moose
Golub
JAMA 2005;294:1108-1110.
FULL TEXT
|
