Perspective: Beyond Counting Hours: The Importance of Supervision, Professionalism, Transitions of Care, and Workload in Residency Training

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 05/2012; 87(7):883-8. DOI: 10.1097/ACM.0b013e318257d57d
Source: PubMed


The medical education community's conversations about residents' duty hours have long focused solely on the number of those hours. In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted its most recent iteration of standards regarding duty hours. Those standards, as well as a 2008 Institute of Medicine report, look beyond the quantity of duty hours to address their quality as well. Indeed, the majority of the 2011 ACGME standards specify requirements for the qualitative components of residents' working and learning environments, including supervision of residents; professionalism, personal responsibility, and patient safety; transitions of care; and clinical responsibilities (including workload). The authors believe that focusing on these qualitative (rather than quantitative) components of the resident's working and learning environment provides the greatest promise for balancing patient care with resident education, thus optimizing the safety and effectiveness of both. For each of the four qualitative components that the authors discuss (enhancing supervision, nurturing professionalism and personal responsibility, ensuring safe transitions of care, and optimizing workloads and cognitive loads), they offer agendas for faculty development, educational program planning, and research. Thus, the authors call on the medical education community to expand its discussion beyond counting duty hours to focus on these critical issues that ensure quality resident education and patient care and to implement necessary strategies to address them.

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    • "However, it is also remarkable what patients themselves can do to help promote a culture of safety (Ministry of Health, 2006; Pearson et al., 2010; Weller, Barrow, & Gasquoine, 2011). Several initiatives seek to create forums and working groups involving different health professionals (e.g., nurses, doctors, pharmacists) and patients (Department of Health, 2007; Okuyama, Martowirono, & Bijnen, 2011; Schumacher et al., 2012), but no formal effective model training exists that is also low cost (Abbott, Fuji, Galt, & Paschal, 2012; Wong, Etchells, Kuper, Levinson, & Shojania , 2010). "
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    ABSTRACT: Background As efforts to address patient safety (PS) in health professional (HP) education increase, it is important to understand new HPs’ perspectives on their own PS competence at entry to practice. This study examines the self-reported PS competence of newly registered nurses, pharmacists and physicians. Methods A cross-sectional survey of 4496 new graduates in medicine (1779), nursing (2196) and pharmacy (521) using the HP Education in PS Survey (H-PEPSS). The H-PEPSS measures HPs’ self-reported PS competence on six socio-cultural dimensions of PS, including culture, teamwork, communication, managing risk, responding to risk and understanding human factors. The H-PEPSS asks about confidence in PS learning in classroom and clinical settings. Results All HP groups reported feeling more confident in the dimension of PS learning related to effective communication with patients and other providers. Greater confidence in PS learning was reported for learning experiences in the clinical setting compared with the class setting with one exception—nurses’ confidence in learning about working in teams with other HPs deteriorated as they moved from thinking about learning in the classroom setting to thinking about learning in the clinical setting. Conclusions Large-scale efforts are required to more deeply and consistently embed PS learning into HP education. However, efforts to embed PS learning in HP education seem to be hampered by deficiencies that persist in the culture of the clinical training environments in which we educate and acculturate new HPs.
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