The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons

Hutter, Matthew M.; Kellogg, Katherine C.; Ferguson, Charles M.; Abbott, William M.; Warshaw, Andrew L.

doi:10.1097/01.sla.0000220042.48310.66

Cited by 358 publications

(273 citation statements)

References 24 publications

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“…Competing demands are motivating a better understanding of surgical processes: surgical procedures are getting more complex [2], residents now have to be trained while performing less procedures [3], the surgical interventions have to be more and more justified [4] and the procedures have to cost less money [5], et caetera. A better understanding of surgical practices is the key component to addressing these issues.…”

Section: Introductionmentioning

confidence: 99%

Non-linear temporal scaling of surgical processes

Forestier¹,

Petitjean²,

Riffaud³

et al. 2014

Artificial Intelligence in Medicine

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Objective. Surgery is one of the riskiest and most important medical acts that is performed today. Understanding the ways in which surgeries are similar or different from each other is of major interest. Desires to improve patient outcomes and surgeon training, and to reduce the costs of surgery, all motivate a better understanding of surgical practices. To facilitate this, surgeons have started recording the activities that are performed during surgery. New methods have to be developed to be able to make the most of this extremely rich and complex data. The objective of this work is to enable the simultaneous comparison of a set of surgeries, in order to be able to extract high-level information about surgical practices. Material and Method.We introduce Non-Linear Temporal Scaling (NLTS): a method to realign a set of surgeries along their intrinsic timeline. Experiments are carried out on a set of lumbar disc neurosurgeries. We assess our method both on a highly standardised phase of the surgery (closure) and on the whole surgery.Results. Experiments show that NLTS makes it possible to consistently derive standards of surgical practice and to understand differences between groups of surgeries. We take the training of * Corresponding author -ENSISA -Universite de Haute Alsace, 12 rue des freres Lumiere, 68093 Mulhouse, France, Tel.:+33 3 8933 6963, Fax.:+33 3 8942 3282Email addresses: germain.forestier@uha.fr (Germain Forestier), francois.petitjean@monash.edu (François Petitjean), laurent.riffaud@chu-rennes.fr (Laurent Riffaud), pierre.jannin@univ-rennes1.fr (Pierre Jannin) Preprint submitted to Artificial Intelligence in MedicineSeptember 16, 2013 surgeons as the common theme for the evaluation of the results and highlight, for example, the main differences between the practices of junior and senior surgeons in the removal of a lumbar disc herniation.Conclusion. NLTS realigns a set of sequences along their intrinsic timeline, which makes it possible to extract standards of surgical practices.Supplementary material. The computer code implementing the proposed methods.

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Section: Introductionmentioning

confidence: 99%

Non-linear temporal scaling of surgical processes

Forestier¹,

Petitjean²,

Riffaud³

et al. 2014

Artificial Intelligence in Medicine

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“…Working-time restriction is mainly investigated in US residents. In most studies, burnout scores decreased significantly with reduced working-time [21–23]. Literature is inconclusive whether this decrease is a consequence of weekly working-time restrictions or a restriction in shift length.…”

Section: Discussionmentioning

confidence: 99%

Exploring the relative importance of work-organizational burnout risk factors in Belgian residents

Willems

Monten

Portzky

2018

Medical Education Online

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Previous research has shown that residents are at risk for developing burnout. Most burnout measures focus on individual risk factors, although work-organizational-focused measures might be beneficial as well. This study analyzed the relative importance of positive and negative work-organizational stressors, according to residents themselves, with NVivo11. Eleven work-organizational themes were found with deductive reasoning and two themes, recognition and success experiences, were found inductively. Main positive stressors are professional development, receiving feedback, experiencing success, autonomy and social support. Main negative stressors are high workloads, role conflicts/ambiguity, long work hours, and a lack of feedback, a lack of social support, and a lack of professional development. Measures to improve residents’ well-being should not only focus on reducing workload and work hours. Our results suggest to allocate resources to improve supervisors’ skills, such as providing social support, feedback, and recognition. A better match between internship obligations and residents’ studies could also contribute positively to this purpose.

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“…11 Search of the references of these studies identified another 14 citations. With further analysis, articles were selected wherein interventions relevant to one or more of the three themes were studied, resulting in a final selection of 56 citations Twenty-one studies analyzed transitions in, during, and after residency education; 19 studies addressed the educational effects of duty hour limits, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 16 articles presented research on use of the competencies in teaching and assessing anesthesiology residents. [19][20][21][22][23][24][25][26][27][52][53][54][55][56][57][58] For the theme ''duty hours and the acquisition of competence'', the only articles included were those that assessed the effect of duty hour limits on measures of physician competence and those that studied changes in patient care experience in anesthesiology that could be attributed to the reduction in resident hours.…”

Section: Methodsmentioning

confidence: 99%

“…One national study 36 and two single institution studies 37,38 found improved scores in the in-training exam in surgical specialties. In a national study of orthopedic surgery residents, 39 three single institution studies in surgery and otolaryngology, [40][41][42] and an older study of the impact of New York state's duty hour regulation on obstetricsgynecology residents 40 showed no changes in in-training exam performance. Among the three studies that assessed the effect of the duty hour reduction on board certification in surgical programs, declining performance was found in a national study of surgery residents 44 and a single institution study of neurological surgery residents, 45 and no change was found in a second single institution study of surgery residents.…”

Section: Duty Hour Limits and The Acquisition Of Competencementioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons

Cited by 358 publications

References 24 publications

Non-linear temporal scaling of surgical processes

Non-linear temporal scaling of surgical processes

Exploring the relative importance of work-organizational burnout risk factors in Belgian residents

Review article: Closing the research gap at the interface of learning and clinical practice

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