Medical Education and the ACGME Duty Hour Requirements: Assessing the Effect of a Day Float System on Educational Activities

Roey, Steve

doi:10.1207/s15328015tlm1801_7

Cited by 8 publications

(12 citation statements)

References 15 publications

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“…Despite reduced learning opportunities, both junior and senior residents valued their learning opportunities, particularly didactic teaching sessions and morning signin rounds (T A B L E 2). This is consistent with literature from internal medicine residency training programs that have adopted a night float system, 7,12,13,15 where residents work several consecutive night shifts during their rotations.…”

Section: Discussionsupporting

confidence: 89%

“…Attend sign-in rounds 16 (25) 40 (64) 7 (11) Attend sign-out rounds 4 (6) 33 (53) 25 (40) Attend critical care didactic teaching sessions 11 (18) 24 (38) 28 (44) Attend midday hospital rounds 4 (6) 28 (45) 30 (48) Complete ICU consults 8 (13) 49 (78) 6 (10) Autonomously assess critically ill patients 14 (22) 41 (65) 8 (13) Place central lines 5 (8) 45 (71) 13 (21) Place arterial lines 6 (10) 44 (70) 13 (21) Perform intubation 5 (8) 46 (73) 12 (19) Read about critical care outside of working hours 8 (13) 30 (48) 25 (40) Abbreviation: ICU, intensive care unit.…”

Section: Improvementmentioning

confidence: 99%

“…1 Although the reduction of resident duty hours may decrease medical errors in the ICU, 1 the effect on resident learning is unclear. Several studies [5][6][7][8][9][10][11][12][13][14][15][16] have evaluated the impact of reduced duty hours on learning in surgical, pediatric, and internal medicine environments. However, there are no published studies that have evaluated its impact on learning in ICU settings where knowledge and procedural skills requirements are different.…”

Section: Introductionmentioning

confidence: 99%

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The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit

Sabri¹,

Sun²,

Cummings³

et al. 2015

Journal of Graduate Medical Education

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Background Many countries have reduced resident duty hours in an effort to promote patient safety and enhance resident quality of life. There are concerns that reducing duty hours may impact residents' learning opportunities. Objectives We (1) evaluated residents' perceptions of their current learning opportunities in a context of reduced duty hours, and (2) explored the perceived change in resident learning opportunities after call length was reduced from 24 continuous hours to 16 hours. Methods We conducted an anonymous, cross-sectional online survey of 240 first-, second-, and third-year residents rotating through 3 McGill University–affiliated intensive care units (ICUs) in Montreal, Quebec, Canada, between July 1, 2012, and June 30, 2013. The survey investigated residents' perceptions of learning opportunities in both the 24-hour and 16-hour systems. Results Of 240 residents, 168 (70%) completed the survey. Of these residents, 63 (38%) had been exposed to both 24-hour and 16-hour call schedules. The majority of respondents (83%) reported that didactic teaching sessions held by ICU staff physicians were useful. However, of the residents trained in both approaches to overnight call, 44% reported a reduction in learner attendance at didactic teaching sessions, 48% reported a reduction in attendance at midday hospital rounds, and 40% reported a perceived reduction in self-directed reading after the implementation of the new call schedule. Conclusions A substantial proportion of residents perceived a reduction in the attendance of instructor-directed and self-directed reading after the implementation of a 16-hour call schedule in the ICU.

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Section: Discussionsupporting

confidence: 89%

Section: Improvementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit

Sabri¹,

Sun²,

Cummings³

et al. 2015

Journal of Graduate Medical Education

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“…Multivariate logistic regression was performed to test patients' ability to identify at least one general medicine physician with the FACE™ card intervention adjusting for patient factors (age, gender, marital status, income, and education level), hospital stay characteristics (length of stay, admission by a night float team, 18-21 whether the attending switched during the admission, 22 and whether the patient was transferred), PCP status (whether the patient had a PCP and whether patient had a University of Chicago PCP), and time (month of admission, academic year). The percentage of patients that had FACE™ cards documented in the room by research assistants was also assessed.…”

Section: Methodsmentioning

confidence: 99%

Improving Inpatients’ Identification of Their Doctors: Use of FACE™ Cards

Arora

Schaninger

Darcy

et al. 2009

The Joint Commission Journal on Quality and Patient Safety

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Background Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. We designed picture cards to facilitate physician introductions. We assessed the effect of Feedback Care and Evaluation (FACE™) cards on patient: (1) ability to correctly identify their inpatient physicians, and (2) understanding of their roles. Methods In October 2006, team members introduced themselves with FACE™ cards, which included a photo and an explanation of their roles. During an inpatient interview research assistants asked patients to name their inpatient physicians and trainees, and rate their understanding of their physicians' roles. Results 1686 (80%) patients in the baseline period and 857 (67%) in the intervention period participated in the evaluation. With the FACE™ intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern) [baseline 12.5% vs. intervention 21.1%; p<0.001]. Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (n=107) had FACE™ cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared to the baseline period (55.3%) (p<0.001). Conclusions Although FACE™ cards improved patients' ability to identify their inpatient physicians, many patients still cannot identify their inpatient doctors. The FACE™ cards also served to highlight patients' misunderstanding of their physicians' roles.

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“…Although residency programs have implemented many creative scheduling changes to accommodate the 2003 ACGME work hours standards, [10][11][12][13] to our knowledge this is the first US program to report complete elimination of the traditional 24-hour call. Successful elimination of 24-hour call was accomplished without an increase in resident complement and at no additional cost to the institution, as neither additional residents nor substitute providers were needed to effect the change.…”

Section: Discussionmentioning

confidence: 99%

Toward a New Paradigm in Graduate Medical Education in the United States: Elimination of the 24-Hour Call

Mautone¹

2009

Journal of Graduate Medical Education

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Evidence was emerging in 2003, and has been corroborated quite conclusively since then, that sleep deprivation negatively affects resident performance and safety. [1][2][3][4][5] Concerns over potential deleterious effects of sleep-deprived residents on patient care prompted efforts to reduce resident work hours. Duty hours limitations for all US residents were instituted by the Accreditation Council for Graduate Medical Education (ACGME) effective July 1, 2003, capping duty hours for most residents at 80 h/wk, mandating defined rest periods between assigned shifts, and limiting consecutive duty hours to 24 plus an additional 6 hours to transfer patient care, participate in educational activities, and attend outpatient clinics. 6 Initially implemented for most workers in 1993, the European Working Time Directive was extended to doctors in training in 2004, setting 13-hour shifts and initially 58 h/wk (to be further reduced to 48 h/wk after 5 years) as the maximum permissible for residents in the European Community. 7,8 In 2003 New Jersey was the first state to adopt Maggie's Law, 9 which upgraded vehicular homicide to a crime of the first degree when caused by a driver who was without sleep for a period in excess of 24 hours.The decision to embark on a major redesign of duty hours for the pediatric residency program at University of Medicine and Dentistry of New Jersey-New Jersey Medical This work was supported in part by a Title VII grant from the Health Resources Services Administration, Bureau of Health Professions, US Department of Health and Human Services, for Residency Training in Primary Care (D58HP05187). The funding agency had no role in data collection and analysis, the decision to publish, or manuscript preparation.The author thanks Dr Soyeon Kim for statistical support. Many thanks also go to the program's residents and faculty, current and former, for their ideas, enthusiasm, commitment to quality patient care, and willingness to embrace change. AbstractBackground Sleep deprivation negatively affects resident performance, education, and safety. Concerns over these effects have prompted efforts to reduce resident hours. This article describes the design and implementation of a scheduling system with no continuous 24-hour calls. Aims included meeting Accreditation Council for Graduate Medical Education work hour requirements without increasing resident complement, maximizing continuity of learning and patient care, maintaining patient care quality, and acceptance by residents, faculty, and administration.

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Medical Education and the ACGME Duty Hour Requirements: Assessing the Effect of a Day Float System on Educational Activities

Abstract: The implementation of a novel day float system for the inpatient medicine ward service improved compliance with ACGME work duty requirements and did not adversely impact educational activities of the residency training program.

Cited by 8 publications

References 15 publications

The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit

The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit

Improving Inpatients’ Identification of Their Doctors: Use of FACE™ Cards

Toward a New Paradigm in Graduate Medical Education in the United States: Elimination of the 24-Hour Call

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