ACGME Duty-Hour Restrictions Decrease Resident Operative Volume: A 5-Year Comparison at an ACGME-Accredited University General Surgery Residency

Damadi, Amir; Davis, Alan T.; Saxe, Andrew; Apelgren, Keith N.

doi:10.1016/j.jsurg.2007.07.008

Cited by 130 publications

(83 citation statements)

References 13 publications

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“…[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

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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.

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Section: Introductionmentioning

confidence: 99%

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

Thériault

Marceau-Grimard²,

Blais

et al. 2017

CUAJ

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“…This finding underscores an important strength of this intervention, namely, successful workload reduction without a concomitant reduction in learning opportunities. Previous studies have shown declines in clinical and operative experience after duty hour reductions [26][27][28][29] ; therefore, it is imperative that programs find ways to manage workload within duty hour limits without compromising learning. 30 We present one model that appears to have extinguished census peaks, which have been shown to adversely impact education, 8 while maintaining the breadth of clinical experience believed necessary to attain clinical competency.…”

Section: Discussionmentioning

confidence: 99%

Service Census Caps and Unit-Based Admissions: Resident Workload, Conference Attendance, Duty Hour Compliance, and Patient Safety

Thanarajasingam

McDonald

Halvorsen

et al. 2012

Mayo Clinic Proceedings

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Objective: To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety. Participants and Methods: We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All other patient safety measures remained unchanged. After adjustment for illness severity, there were no significant differences in patient outcomes between resident and nonresident services. Conclusion: Census caps and unit-based admissions were associated with improvements in resident workload, conference attendance, duty hour compliance, and readmission rates while patient outcomes were maintained.

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“…[4][5][6] This laborious process of proctored, on-site training programs is time consuming and significantly impinges on the residents' pre-existing didactic requirements, patient care responsibilities, and overall operative experience. [7][8][9] In fact, duty-hour limitations have led to a significant re-evaluation of the traditional surgical education paradigm, with emphasis on increased efficiency of educational efforts. Accordingly, a disadvantage of these on-site training facilities is that they are often not readily accessible to the resident.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent approaches

Bellows¹,

Smith²

2017

MIS

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How to cite this article: Bellows CF, Smith AA. Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent approaches. Mini-invasive Surg 2017;1:126-32. Quick Response Code: Original ArticleThis is an open access article licensed under the terms of Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the identical terms. For reprints contact: service@oaepublish.com Open AccessBellows et al. Mini-invasive Surg 2017;1:126-32 DOI: 10.20517/25741:126-32 DOI: 10.20517/ -12251:126-32 DOI: 10.20517/ .2017 Mini-invasive Surgery www.misjournal.net Aim: Current financial and work hour constraints make proctored on-site laparoscopic simulation training challenging. An independent learning approach utilizing proficiency-based training is a potential solution. The purpose of this study was to determine if an independent approach using a portable, laparoscopic training device within one's home environment could effectively train novices in laparoscopic procedural skills. Methods: After baseline testing, laparoscopic novices (n = 16) were randomized to one of two study groups. The on-site group (n = 7) received unlimited access to the workplace laparoscopic trainers and the home group (n = 9) received portable laparoscopic trainers for home. Both groups underwent self-directed, proficiency-based training for three months then were retested. Results were compared with parametric and non-parametric statistical tests. Results: Baseline characteristics were similar between groups. The practice rate (56%) and practice time (range, 0.18 to 2.6 h) were poor in both groups during the training period. At post-test, the number of participants who demonstrated an improvement (86% on-site, 78% home) on the peg task was not different between groups. The successful completion of the suturing task post-test had significantly improved compared with pre-test in both groups (71% vs. 29% on-site; 44% vs. 22% home, P < 0.001). Although the majority of participants reported it was difficult to practice on a regular basis (86% on-site, 89% home), 56% of the home group participants agreed that the at-home trainer was a helpful teaching modality. Conclusion: Learning of laparoscopic skills by novice trainees can be augmented by an independent learning approach using either home or on-site laparoscopic trainers. Although over half the candidates found it was useful to have the training device at home, none of the participants practiced more than an hour or two in the three month training period. Thus, the solution to conducting training does not lie in merely providing home training, but rather to understand the work-related stressors and reconfigure jobs. Key words:Laparoscopic surgery, training, medical education, proficiency, simulation, independent learning ABSTRACT Article history:

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ACGME Duty-Hour Restrictions Decrease Resident Operative Volume: A 5-Year Comparison at an ACGME-Accredited University General Surgery Residency

Cited by 130 publications

References 13 publications

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

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

Service Census Caps and Unit-Based Admissions: Resident Workload, Conference Attendance, Duty Hour Compliance, and Patient Safety

Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent approaches

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