Impact of resident work-hour restrictions on trauma care
ABSTRACT In July 2003, the American Council for Graduate Medical Education (ACGME) required residency programs to significantly restrict resident work hours. The effect of these regulations on trauma services has not yet been investigated. The purpose of this study was to evaluate the effect of the ACGME regulations on the care of injured patients and resident education.
A 24-question instrument was mailed to a sample of senior trauma surgeons.
Shift work has become significantly more common among trauma residents since July 2003 (14% vs. 53.4%, (P < .001)). Fifty-four percent of respondents believed that trauma education has worsened and 45% believed that patient care has worsened as a result of the work-hour restrictions.
The ACGME-mandated work-hour restrictions have had a dramatic effect on resident and staff surgeons involved in the care of injured patients. Appropriate methods of responding to these challenges must be developed to improve trauma care and enhance resident education.
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ABSTRACT: Trauma video review (TVR) is an effective method of quality improvement and education. The objective of this study was to determine TVR practices in the United States and use of TVR for quality improvement and education. Adult and pediatric trauma centers identified by the American College of Surgeons (n = 102) and the National Association of Children's Hospitals and Related Institutions (n = 24) were surveyed by telephone. Surveys included questions regarding program demographics, residency information, and past/present TVR practices. One hundred eight trauma centers (86%) were contacted, and 99% (107/108) completed surveys. Of the surveyed centers, 34% never used TVR; 37% previously used TVR and had discontinued at the time of the survey, with most reporting legal/privacy concerns; 20% were currently using TVR; and 9% were planning to use TVR in the future. Nineteen percent (14/73) of general trauma centers are using or planning to use TVR compared with 50% (17/34) of pediatric centers (P = 0.001). One hundred percent of current TVR programs report that TVR improves the trauma resuscitation process.Most pediatric emergency medicine (87%), emergency medicine (89%), and surgery (97%) trainees participate in trauma resuscitation at trauma centers. Fifty-two percent of centers using TVR report trainee attendance at TVR process/conference; 38% specifically use TVR for resident education. All current TVR programs report that it improves their trauma processes. More pediatric trauma centers report planning future TVR programs, but the implication of such plans remains unclear. Opportunities exist for expanded use of TVR for resident education.Pediatric emergency care 10/2010; 26(11):803-7. DOI:10.1097/PEC.0b013e3181fa874a · 0.92 Impact Factor
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ABSTRACT: Educators in surgical training programs are concerned that the Accreditation Council for Graduate Medical Education (ACGME) duty hours limitations may adversely affect surgical residents' education, especially their operative experience, so the authors aimed to evaluate the impact of duty hours reductions on surgical residency. The authors searched English- and French-language literature (2000-2008) for articles about the impact of duty hours restrictions on surgical residents' education and well-being and on faculty educators. They used the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ERIC. The authors included every report that examined the effects of duty hours limits on surgical training, excluding opinion papers and editorials. Two reviewers independently performed data extraction and quality assessment for all reports and resolved disagreements by consensus. The authors retrieved 1,146 reports and included 56 in the study. They compiled positive and negative outcomes on (1) residents' education, (2) resident lifestyle, and (3) surgical faculty. Overall, the effects of duty hours reductions on residents' education and lifestyle were positive or neutral, but the effects on surgical faculty were negative. The 16 articles with the highest-quality scores had 27 positive themes and 11 negative themes. This is the largest and most current review of the literature addressing the effect of the ACGME duty hours limitations on surgical training. Limitations had a positive effect on residents but a negative effect on surgical faculty. Importantly, duty hours limitations did not adversely affect surgical residents' operating-room experience.Academic medicine: journal of the Association of American Medical Colleges 01/2011; 86(1):34-42. DOI:10.1097/ACM.0b013e3181ffb264 · 3.47 Impact Factor