A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery

Ahmed, Najma; Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane S.; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd G.; Warren, Richard; Fata, Paola; Gorman, Mark; Feinberg, Stan; Rutka, James T.

doi:10.1097/sla.0000000000000595

Cited by 461 publications

(300 citation statements)

References 88 publications

Supporting

Mentioning

281

Contrasting

Unclassified

Order By: Relevance

“…[24][25][26][27][28] In the same context, a recent study has shown that postcall-related fatigue was associated with decreased surgical skills in the operative room. 29 More, as described earlier, if the resident is performing call duty at home and has worked for 18 hours during a 24-hour period, he shall be released from his regular schedule following his call period for at least 24 hours, it could be relevant to examine how often these situations happened.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Urology residents on call: Investigating the workload and relevance of calls

Thériault

Marceau-Grimard²,

Blais

et al. 2017

CUAJ

View full text Add to dashboard Cite

Introduction: On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really is. As part of an effort to ameliorate our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls. Method: We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre-and post-collecting period questionnaires. Results: A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean (median, range) of 3.5 (3, 0-12) calls per weeknight and 7.7 (6, 0-23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultation (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls. Conclusions: Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.

show abstract

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Canada does not have uniform, panCanadian legislation governing aspects of the working environment for residents. In most provinces, there is a limit of 24 hours for a single call shift.…”

Section: Introductionmentioning

confidence: 99%

Urology residents on call: Investigating the workload and relevance of calls

Thériault

Marceau-Grimard²,

Blais

et al. 2017

CUAJ

View full text Add to dashboard Cite

show abstract

“…These shortcomings may be linked to recent changes in surgical training environments, including working time restrictions that limit opportunities for trainees to gain proficiency in surgical skills4. Systematic reviews and meta‐analyses5 6 suggest that these restrictions have not improved patient safety in relation to surgical procedures, with some7, 8, 9 suggesting increased complication and morbidity rates. Reduced training opportunities and skill proficiency may be contributing factors4.…”

Section: Introductionmentioning

confidence: 99%

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

View full text Add to dashboard Cite

BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct‐current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation‐based laparoscopic surgical skill acquisition.MethodsIn this double‐blind, sham‐controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation‐based training. Primary outcomes of laparoscopic pattern‐cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent‐to‐treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern‐cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non‐simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

show abstract

“…Numerous studies have linked resident workload to wellness and education [1][2][3][4][5][6] ; however, the vast majority of existing research on resident workloads has focused on the quantity of hours worked, rather than the content of those hours. Additionally, most research has studied self-reported hours data, which can be unreliable.…”

mentioning

confidence: 99%