Resident Workload—Let's Treat the Disease, Not Just the Symptom

Goitein, Lara; Ludmerer, Kenneth M.

doi:10.1001/jamainternmed.2013.740

Cited by 31 publications

(28 citation statements)

References 10 publications

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“…The issue of increased work intensity and greater stress was noted among US residents when working hours were further restricted 43. Performing the same amount of work in fewer hours (work compression) is of concern regarding workload44 and overall well-being,45 and may place trainee doctors at risk of burnout 46. Although much of the literature relating to fatigue comes from the USA where restricted working hours are still much longer than in Europe (eg, 80 h/week and longer maximum shift lengths), two UK self-report studies conducted shortly after implementation of the 48 h working week have highlighted the effect of different schedules on fatigue, including the negative effect of working 7 consecutive nights, having only 1 day of rest after night shifts, intervals of less than 10 h between shifts, and shifts of 12 consecutive days 30 31.…”

Section: Discussionmentioning

confidence: 99%

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

et al. 2014

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ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors’ experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.Setting9 deaneries in all four UK nations; secondary care.Participants82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.ResultsImplementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.ConclusionsLong-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors’ true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.

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Section: Discussionmentioning

confidence: 99%

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

et al. 2014

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“…Additionally, patient complexity has increased over the last decade while average patient length of inpatient stay has decreased. 16 Thus, trainees are caring for sicker patients with less continuous time, resulting in further WLC. Goitein and Ludmerer further suggest, Bfocusing on work hours rather than workload, the ACGME…treated the symptom, not the disease.^1 7(pp655) In contrast to WLC, some educators 18 have advocated for Bworkload reduction^(WLR) strategies for PGY-1 internal medicine trainees, essentially reducing the admitting volume and patient census per trainee.…”

Section: Introductionmentioning

confidence: 99%

Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training

et al. 2016

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“…Educating residents in the current frenetic inpatient environment, in which billing, patient satisfaction, and work hours are significant pressures, poses challenges. [1][2][3] Hospital leadership is attuned to optimizing throughput and is focused on identifying interventions that move up the time of patients' discharge. Delayed discharges may curtail hospital efforts at efficiency, quality of care, and patient satisfaction, and longer hospitalizations have been associated with an increased cost and risk of iatrogenic morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

Campbell¹,

Campbell²,

Shah³

et al. 2014

Journal of Graduate Medical Education

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Background Limits on resident duty hours instituted in 2003 and 2011 have compressed medical resident daily workload. Despite this compression, residents must gain competence to practice medicine without supervision. Objective We sought to determine whether moving the time our educational conference is scheduled affects the time when patient discharges are completed on an internal medicine teaching service. Methods The study was conducted at a county hospital within a large internal medicine residency program. During the 4-month study period, the morning report conference for internal medicine residents was shifted from 8:30 am to 2 pm. Patient discharge times, defined as the time the discharge order set was signed, were obtained for the service via the electronic health record. The outcomes measured were patient discharge time variation and internal medicine resident preference for conference time. Results Survey response rate was 82% (42 of 51). Of the residents who responded, 64% (27 of 42) preferred the 8:30 am report time, and 74% (31 of 42) felt the 8:30 am time was also better for education and timing of teaching rounds. There was no difference in discharge times for 2999 patients on the medicine teaching service, whether educational case conference morning report occurred at 8:30 am or at 2 pm. Conclusions Medical patient average discharge time was not influenced by time of educational conference. Factors other than the timing of educational conference appear to influence hospital discharge times on an inpatient internal medicine service.

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Resident Workload—Let's Treat the Disease, Not Just the Symptom

Cited by 31 publications

References 10 publications

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training

Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

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