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首页> 外文期刊>Journal of neurosurgery. >Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.
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Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.

机译：研究生医学教育认可委员会工作时间规定对神经外科住院医师教育和生产力的影响。

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Object Recently, the Institute of Medicine examined resident duty hours and their impact on patient safety. Experts have suggested that reducing resident work hours to 56 hours per week would further decrease medical errors. Although some reports have indicated that cutbacks in resident duty hours reduce errors and make resident life safer, few authors have specifically analyzed the effect of the Accreditation Council for Graduate Medical Education (ACGME) duty-hour limits on neurosurgical resident education and the perceived quality of training. The authors have evaluated multiple objective surrogate markers of resident performance and quality of training to determine the impact of the 80-hour workweek. Methods The United States Medical Licensing Examination (USMLE) Step 1 data on neurosurgical applicants entering ACGME-accredited programs between 1998 and 2007 (before and after the implementation of the work-hour rules) were obtained from the Society of Neurological Surgeons. The American Board of Neurological Surgery (ABNS) written examination scores for this group of residents were also acquired. Resident registration for and presentations at the American Association of Neurological Surgeons (AANS) annual meetings between 2002 and 2007 were examined as a measure of resident academic productivity. As a case example, the authors analyzed the distribution of resident training hours in the University of Virginia (UVA) neurosurgical training program before and after the institution of the 80-hour workweek. Finally, program directors and chief residents in ACGME-accredited programs were surveyed regarding the effects of the 80-hour workweek on patient care, resident training, surgical experience, patient safety, and patient access to quality care. Respondents were also queried about their perceptions of a 56-hour workweek. Results Despite stable mean USMLE Step 1 scores for matched applicants to neurosurgery programs between 2000 and 2008, ABNS written examination scores for residents taking the exam for self-assessment decreased from 310 in 2002 to 259 in 2006 (16% decrease, p < 0.05). The mean scores for applicants completing the written examination for credit also did not change significantly during this period. Although there was an increase in the number of resident registrations to the AANS meetings, the number of abstracts presented by residents decreased from 345 in 2002 to 318 in 2007 (7% decrease, p < 0.05). An analysis of the UVA experience suggested that the 80-hour workweek leads to a notable increase in on-call duty hours with a profound decrease in the number of hours spent in conference and the operating room. Survey responses were obtained from 110 program directors (78% response rate) and 122 chief residents (76% response rate). Most chief residents and program directors believed the 80-hour workweek compromised resident training (96%) and decreased resident surgical experience (98%). Respondents also believed that the 80-hour workweek threatened patient safety (96% of program directors and 78% of chief residents) and access to quality care (82% of program directors and 87% of chief residents). When asked about the effects of a 56-hour workweek, all program directors and 98% of the chief residents indicated that resident training and surgical education would be further compromised. Most respondents (95% of program directors and 84% of chief residents) also believed that additional work-hour restrictions would jeopardize patient care. Conclusions Neurological surgery continues to attract top-quality resident applicants. Test scores and levels of participation in national conferences, however, indicate that the 80-hour workweek may adversely affect resident training. Subjectively, neurosurgical program directors and chief residents believe that the 80-hour workweek makes neurosurgical training and the care of patients more difficult. Based on experience with the 80-hour workweek, educators think that a 56-hour wo
机译：对象最近，医学研究所检查了居民值勤时间及其对患者安全的影响。专家建议将居民工作时间减少到每周56小时将进一步减少医疗错误。尽管一些报告表明减少在职时间减少了错误并使居民的生活更安全，但很少有作者专门分析了美国研究生医学教育认证委员会（ACGME）的工作时间限制对神经外科住院医师教育的影响以及对患者的感知质量。训练。作者评估了居民表现和培训质量的多个客观替代指标，以确定每周工作80小时的影响。方法美国医学许可考试（USMLE）步骤1的数据是从1998年至2007年（实施工作时间规则的前后）进入ACGME认可计划的神经外科申请人的数据。还获得了美国神经外科手术委员会（ABNS）针对该组居民的笔试成绩。考察了2002年至2007年间美国神经外科医师协会（AANS）年度会议的居民登记和演示情况，以此作为衡量居民学术生产力的一种方法。作为一个例子，作者分析了在实行每周80小时工作制之前和之后，弗吉尼亚大学（UVA）神经外科培训计划中居民培训时间的分布。最后，对ACGME认可的计划的项目负责人和主要居民进行了调查，以了解每周80小时工作对患者护理，住院医师培训，手术经验，患者安全以及患者获得优质护理的影响。还向受访者询问他们对每周工作56小时的看法。结果尽管2000年至2008年间，神经外科计划匹配申请人的USMLE第一步平均得分保持稳定，但参加自我评估考试的居民的ABNS笔试得分从2002年的310降至2006年的259（下降16％，p <0.05） 。在此期间，完成笔试的笔试的平均得分也没有明显变化。尽管参加AANS会议的居民登记数量有所增加，但居民提交的摘要数量已从2002年的345减少到2007年的318（减少了7％，p <0.05）。对UVA经验的分析表明，每周工作80小时会大大增加值班时间，而大大减少了在会议和手术室中花费的时间。调查反馈来自110位项目总监（78％的回应率）和122位主要居民（76％的回应率）。大多数主要居民和项目主管认为，每周工作80小时会损害居民培训（96％），减少居民手术经验（98％）。受访者还认为，每周工作80小时威胁着患者的安全（96％的项目主管和78％的主要居民）和获得优质护理（82％的项目主管和87％的主要居民）。当被问及每周工作56个小时的影响时，所有计划负责人和98％的主要居民都表示，居民培训和外科教育将进一步受到影响。大多数受访者（95％的项目主管和84％的主要居民）还认为，额外的工作时间限制会危害患者的护理。结论神经外科手术继续吸引着高质量的住院医师。但是，考试成绩和参加全国会议的水平表明，每周工作80小时可能会对居民培训产生不利影响。从主观上讲，神经外科计划主任和主要住院医师认为，每周工作80小时使神经外科培训和患者护理更加困难。根据每周工作80小时的经验，教育工作者认为工作56小时

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