Beyond work-hour restrictions: a qualitative study of residents’ subjective workload

Nishigori, Hiroshi; Deshpande, Gautam A.; Obara, Hideaki; Takahashi, Osamu; Busari, Jamiu O; Dornan, Tim

doi:10.1007/s40037-015-0198-4

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…[ 40 ] A qualitative study revealed that Japanese residents decreased their subjective workload when they felt that they could control their job and have a fulfilling personal life. [ 41 ] In addition, the Japan Society for Medical Education presented a draft version of the core competency of medical professionalism, which consisted of 7 subdomains, with “self-control and career development” included as one of the domains.…”

Section: Discussionmentioning

confidence: 99%

Limitation of duty hour regulations for pediatric resident wellness

et al. 2016

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Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents.A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout.Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work–life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout.Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident–faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.

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Section: Discussionmentioning

confidence: 99%

Limitation of duty hour regulations for pediatric resident wellness

et al. 2016

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“… 25 Our findings suggest that similar to patient safety, there are nuances to the theme of ‘resident well-being’ in the context of RDH, specific number of hours off between shifts and number of consecutive night floats. 26 …”

Section: Discussionmentioning

confidence: 99%

Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums

2022

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ObjectiveResident duty hour (RDH) restrictions in postgraduate medical education is a controversial yet important topic for study. There is limited literature on authentic trainee perceptions surrounding RDH restrictions to inform evaluation and future planning. Online forums are a widely accessible, yet underused resource, for insight into trainee perceptions. Our objective was to qualitatively assess trainee perceptions of RDH restrictions on online discussion forums.SettingOnline discussion forums; Premed101 (Canadian forum) and Student Doctor Network (SDN) (American forum).Participants6630 posts from 161 discussion threads; comprising 429 posts in 14 threads from Premed101 and 6201 posts in 147 threads from SDN. Posters included medical students, residents and attending physicians.DesignData were analysed inductively and iteratively to create themes and subthemes. Cocoding, consensus-based decision making and an audit trail were used to ensure trustworthiness.ResultsKey findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties and the inter-relationship between fatigue and patient safety. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations were also featured on the American SDN forum.ConclusionsThe findings of this study reveal multiple themes pertinent to the implementation and revision of RDH restrictions. The most prominent theme was the inapplicability of blanket restrictions on duty hours theme due to the diversity of training needs across specialties and the environmental context of training programmes. Other discussions included the inter-relationship of patient safety and resident competence with duty hours. Lastly, concerns regarding the lack of transparency and psychological safety surrounding RDH violations, were discussed.

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“…The limited Japanese research on mental health during residency also focuses on the influence of trainee psychological qualities (ability to cope with stress) and interpersonal relationships. 15,[38][39][40][41] The single Japanese study that trialed restriction of resident work hours identified no decrease in the prevalence of depression or burnout. 15 The other main distinguishing theme of Japanese residency was the breadth of clinical skills acquired, including facility with bedside procedures and radiology image interpretation.…”

Section: Themes and Acgme Core Requirementsmentioning

confidence: 99%

Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems

Heist

Torok

2019

Journal of Graduate Medical Education

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Background International medical graduates (IMGs) have significant exposure to clinical training in their home country, which provides opportunity for international comparison of training experiences. One relevant IMG population is Japanese physicians who have completed some training before entering residency programs in the United States and desire to improve medical education in Japan. Objective We examined Japanese IMGs' perceptions of the respective attributes of residency in the United States and Japan. Methods Individual semistructured interviews were conducted with 33 purposively sampled Japanese IMGs who had completed training. We used exploratory thematic analysis, iterative data collection, and thematic analyses with constant comparison. Results Comments were organized into 3 categories: (1) attributes of US residency preferable to Japanese residency; (2) attributes of residency training with no clear preference for the US or Japanese systems; and (3) attributes of Japanese residency preferable to US residency. Within each category, we matched themes to residency program requirements or culture of medical training. Main themes include high regard for Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, with emphasis on efficient achievement of clinical competency through graded responsibility, contrasted with preference expressed for a Japanese training culture of increased professional commitment facilitated by a lack of work hour limits and development of broad clinician skills, including bedside procedures and radiology interpretation. Conclusions Japanese training culture contrasts with a US model that is increasingly focused on work-life balance and associated compartmentalization of patient care. These findings enhance our understanding of the global medical education landscape and challenges to international standardization of training.

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Beyond work-hour restrictions: a qualitative study of residents’ subjective workload

Cited by 7 publications

References 18 publications

Limitation of duty hour regulations for pediatric resident wellness

Limitation of duty hour regulations for pediatric resident wellness

Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums

Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems

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