On resident duty hour restrictions and neurosurgical training: review of the literature

Bina, Robert; Lemole, Gerald M.; Dumont, Travis M.

doi:10.3171/2015.3.jns142796

Cited by 34 publications

(12 citation statements)

References 48 publications

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“…The rigorous work hours that were historically demanded during training were also felt to contribute to a decreased quality of life and physician burnout [3, 10, 16, 18]. However, now there is concern that these hour restrictions have limited educational opportunities that are critical to the training of a neurological surgeon [7, 11-13, 19]. Decreasing clinical and operative exposure could be having a deleterious impact on the maturation of critical thinking and technical skills that were felt to be endangered by fatigue [1, 5-6, 8, 12-13, 19].…”

Section: Introductionmentioning

confidence: 99%

The Effects of 24-Hour Neurosurgical Call on Fine Motor Dexterity, Cognition, and Mood

Rogers

Saway

Büsch

et al. 2019

Cureus

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Background: Concerns regarding the effects of fatigue on physician performance and quality of life lead to the implementation of duty hour restrictions for residents by the Accreditation Council for Graduate Medical Education (ACGME). These restrictions have been met by strong criticism from the neurosurgical community. This is partly due to a lack of objective evidence that fatigue results in decrements in professional function in neurological surgeons. There is also concern that the restrictions have diminished clinical and operative experience as well as the development of professional responsibility in residency.Objective: To evaluate whether 24-hour neurosurgical call has an objective impact on fine motor dexterity, cognitive thinking skills, and mental well-being.Methods: Subjects were tested before and after taking 24 hours of neurosurgical call. We evaluated fine motor dexterity using the Vienna Test System Motor Performance Series, cognitive thinking abilities using a battery of paper-pencil neuropsychological tests, and mental well-being using the Profile of Mood States. Results: A total of 27 subjects were included in this study, 12 seasoned to neurosurgical call and 15 naive to neurosurgical call. The seasoned subjects demonstrated no statistically significant change in performance after call on any of the tests for fine motor dexterity or cognitive thinking abilities. The nonseasoned subjects demonstrated multiple decrements in fine motor dexterity and cognitive thinking abilities after taking call. In the Motor Performance Series, they had a statistically significant decrease in the speed of untargeted movements in the nondominant hand during the tapping test (p = 0.002), and a decline in the precision of fine motor movements and information processing as evidenced by an increase in the number of errors of the dominant hand in the line tracking test (p = 0.014). There was a statistically significant decline in their immediate memory during Hopkins Verbal Learning Test (p = 0.025), and complex attention, mental flexibility, and visual-motor speed in the Trail Making Test (p = 0.03). The Profile of Mood States found no difference in feelings of anger (p = 0.54), tension (p = 0.358), or depression (p = 0.65). There were increased feelings of confusion (p < 0.001) and decreased feelings of vigor (p < 0.001) and friendliness (p = 0.001). Nonseasoned subjects had an increase in total mood disturbance (p = 0.012) but seasoned subjects did not (p = 0.083). Conclusion: Our results suggest that fatigue-induced decrements in professional function can be ameliorated by experience with prolonged duty hours. In contrast to nonseasoned subjects, those who were conditioned to 24-hour neurosurgical call demonstrated resilience in fine motor dexterity and cognitive thinking skills, and exhibited no change in total mood disturbance. An argument can be made that we are turning the neurosurgical training paradigm upside down with the current ACGME duty hour restrictions.

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Section: Introductionmentioning

confidence: 99%

The Effects of 24-Hour Neurosurgical Call on Fine Motor Dexterity, Cognition, and Mood

Rogers

Saway

Büsch

et al. 2019

Cureus

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“…Em Portugal, os estudos sobre a formação especializada em Neurocirurgia são escassos, impedindo a identificação das referidas dissemelhanças formativas existentes a nível nacional e internacional, nomeadamente quanto ao número de horas de trabalho, ao género dos médicos internos, à publicação de artigos e à carreira académica. [10][11][12][13][14][15][16][17][18] É opinião dos autores que a satisfação dos médicos internos pode ser influenciada por vários fatores previamente identificados em estudos internacionais, como características e organização dos serviços, carga horária, distribuição de tarefas e oportunidades formativas (teóricas e práticas) disponibilizadas.…”

Section: Enquadramento E Formulação Do Estudounclassified

O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

Dias¹,

Leite

Reizinho³

et al. 2022

Acta Med Port

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Introduction: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal.Material and Methods: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019.Results: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years’ residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with thefinal examination (37.8%).Conclusion: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

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“…Institutions can incorporate resiliency trainings and develop strategies that entice physicians to achieve work-life balance that mirrors high level practice standards [41]. For example, when the Accreditation Council of Graduate Medical Education capped the residents work hours to 80 hours a week in hopes of improving burnout from a foundational level however, the medical community was mixed with emotions [42]. A pilot program initiated at Stanford Hospital in California known as "time banking" was adopted to counteract the rising rates of burnout by allowing physicians to bank their unpaid and additional responsibility hours to be used for personal things outside of work [32].…”

Section: Figurementioning

confidence: 99%

Physician Burnout Quality of Life/ Wellness Resource Pilot Program

2019

JCRC

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Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work [1]. Despite the efforts to combat burnout, the number of U.S. physicians who experience burnout rose from 45 percent to over 50 percent between 2011 and 2014. The purpose of this quality improvement evidence-based capstone project was to determine whether a physician wellness pilot program could reduce and or eliminate burnout and stress for practicing physicians at an acute care healthcare institution in the Chicago metropolitan area. The capstone project consisted of a pre-intervention survey, an intervention and a post intervention survey. The participants targeted for this evidence-based project were practicing physicians in Illinois that span across all specialty groups. The physician burnout wellness pilot program was implemented during a two-week period of time during which participants were provided with resources to reduce and or eliminate symptoms of burnout. The implementation of the physician wellness pilot program capstone project showed the physicians at this organization were less stressed and more satisfied with their job at (0.555) percent compared to pre intervention survey results that faired (0.77) and that of the national average of (0.80). Additionally, the post intervention survey results showed the physicians at this organization are experiencing a lower level of burnout (0.44) percent compared to pre intervention survey results that faired (0.53), but a higher level of burnout compared to the national average (0.29). Physician burnout is an epidemic that requires immediate attention because it not only effects the physicians, but it effects the healthcare system. As such, regardless of the specialty and demographics of the physicians, organizations and physicians alike must do their part in assessing if burnout exists. The findings showed the importance of physicians being able to recognize the warning signs of burnout, encourage them to seek help when they are stressed, and take active steps towards ridding or reducing burnout. The findings were compatible with evidence-based research that supports building physician resilience by way of the development of a wellness program. There is an alarmingly high prevalence of burnout amongst the working class in the United States. Strikingly it is even greater for physicians, particularly the front-line practitioner’s family medicine, general internal medicine and emergency medicine [2]. However, in recent years, the effect of burnout became even more evident when the increasing demand for doctors, coupled with the rising rates of physician burnout, threatened many organizations abilities to consistently deliver quality care and maintain a healthy physician workforce [3]. Consequently, burnout started to negatively impact health outcomes for both physicians and the patients they serve. Since burnout affects doctors in both individual practices and hospitals across the county, it is now viewed as a nationwide problem [4]. According to West, Dyrbye, Liselotte & Shanafelt, rates of burnout symptoms associated with adverse effects on patients, the healthcare workforce, costs, and physician health exceed 50% in studies of both physicians-in-training and practicing physicians [5]. A survey presented by Medscape Physician Lifestyle in 2015 reported that the rate of burnout has increased by 46 percent, which is double the rate of burnout in 2013 [6]. This data shows that the physician burnout rate is on the rise and has increased significantly with every passing year [6].

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On resident duty hour restrictions and neurosurgical training: review of the literature

Cited by 34 publications

References 48 publications

The Effects of 24-Hour Neurosurgical Call on Fine Motor Dexterity, Cognition, and Mood

The Effects of 24-Hour Neurosurgical Call on Fine Motor Dexterity, Cognition, and Mood

O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

Physician Burnout Quality of Life/ Wellness Resource Pilot Program

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