Limitation of duty hour regulations for pediatric resident wellness

Nomura, Osamu; Mishina, Hiroki; Kobayashi, Yoshinori; Ishiguro, Akira; Sakai, Hirokazu; Kato, Hiroyuki

doi:10.1097/md.0000000000004867

Cited by 17 publications

(37 citation statements)

References 36 publications

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“…We implemented a new OCS system in July 2011 to improve residents’ working conditions. Under the new system, residents have 8 off hours after the morning rounds on the same day they have an OCS (Table ) . On the next day of their night shift, residents have no patient care duties after attending the hand‐off meeting and writing the charts.…”

Section: Methodsmentioning

confidence: 99%

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Pediatric resident perceptions of shift work in ward rotations

Nomura

Mishina

Jasti

et al. 2017

Pediatrics International

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Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education.

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Section: Methodsmentioning

confidence: 99%

“…Under the new system, residents have 8 off hours after the morning rounds on the same day they have an OCS (Table 1). 5 On the next day of their night shift, residents have no patient care duties after attending the hand-off meeting and writing the charts. Thus residents have at least 20 off hours after their night shift.…”

Section: Study Setting and Participantsmentioning

confidence: 99%

Pediatric resident perceptions of shift work in ward rotations

Nomura

Mishina

Jasti

et al. 2017

Pediatrics International

Self Cite

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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%

“…8,12,13 There is limited research on physician wellness in Japan and no discussion of work hour limits in residency requirements. 14,15 Instructional guidelines for residency training in Japan recommend aligning training with US residency attributes but are not legally binding. 16 There is variation in the training experience across programs, and Japan's modest specialty certification criteria have prompted concern about physician competency.…”

Section: Introductionmentioning

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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“…Graduate medical education (GME) exposes medical students and physicians in training to the realities of medical care, including long work hours and a set of professional expectations that often place patients' needs above the practitioner's own [7,8]. Traditionally, physician training programs in the United States extolled extensive work hours in order to facilitate learning and professional socialization of physicians.…”

Section: History Of Extensive Duty Hours For Graduate Medical Educatimentioning

confidence: 99%

The Impact of Fatigue on Medical Error and Clinician Wellness: A Vignette-Based Discussion

Salen¹,

Norman²

2018

Vignettes in Patient Safety - Volume 2

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Fatigue-induced medical errors and complications spark concern in patients, clinicians, and policy makers, as documented by the Institute of Medicine report in 1999 that approximately 100,000 Americans die annually secondary to potentially avoidable injurious events. Over the last 2 decades, multiple organizations have advocated for the implementation of labor hour restrictions to redress physician in training fatigue and enhance patient safety. Advocates for duty hour caps in physician training programs cite the potential for improvements in patient safety, whereas adversaries allege that curtailing duty hours compromises medical education and readiness for solo practice. Sleep deprivation impairs multiple aspects of cognition, function, and capacity, including many aspects essential to the practice of medicine, e.g., cognizance, recollection, and dexterity. Resident physicians' traditional extended duty shifts for 24-30 consecutive hours pose significant hazards not only to patients but also to the physicians in training themselves. Burnout among physicians in training occurs commonly and results from work-related stress characterized by emotional prostration, depersonalization manifest as cynicism and detachment toward patients, and diminution of personal esteem. Curtailed shift duration correlates best with improved patient care of the strategies for managing physician fatigue. Adequate supervision of residents and medical students has the potential to improve resident education and further patient safety. Night float shifts improve resident's well-being in terms of acclimating to a consistent nocturnal schedule. Data supporting capping physician work hours demonstrates evidence of amelioration of fatigue, thereby improving physician's quality of life; evidence supporting duty hour restriction for enhancing patient safety, decreasing medical errors, and physician training, including surgical, is mixed and more nuanced.

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Limitation of duty hour regulations for pediatric resident wellness

Cited by 17 publications

References 36 publications

Pediatric resident perceptions of shift work in ward rotations

Pediatric resident perceptions of shift work in ward rotations

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

The Impact of Fatigue on Medical Error and Clinician Wellness: A Vignette-Based Discussion

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