reduced residents work hours: perceived impact on surgical training & patient care philippine...

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING &

PATIENT CARE PHILIPPINE COLLEGE OF SURGEONS (PCS)

and PHILIPPINE ASSOCIATION OF TRAINING OFFICERS IN SURGERY

(PATOS)

PHILIPPINE COLLEGE OF SURGEONS62ND ANNUAL CLINICAL CONGRESS

Kamia Rm. EDSA Shangrila HotelMandaluyong City

December 3 (Sunday), 2006

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“SLEEP IS A STRANGER TO MANY MANAGERS. RESEARCH BY LEADING SCIENTISTS SHOWS JUST HOW DANGEROUS THAT PROBLEM IS”

• PROF. CHARLES A. SZEISLER, BALDINO PROFESSOR OF SLEEP MEDICINE

• SLEEP DEFICIT: THE PERFORMANCE KILLER

• HARVARD MEDICAL SCHOOL

• OCTOBER 2006

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“STAY AWAKE LONGER THAN 18 CONSECUTIVE HOURS, AND YOUR REACTION SPEED, SHORT-TERM & LONG-TERM MEMORY, ABILITY TO FOCUS, DECISION-MAKING CAPACITY, MATH PROCESSING, COGNITIVE SPEED, AND SPATIAL ORIENTATION ALL START TO SUFFER”

• DITTO

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“....FRENZIED CULTURES STILL CONFUSE SLEEPLESSNESS WITH VITALITY AND HIGH PERFORMANCE...”

• DITTO

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“....THIS IS REASON PERHAPS THAT AMONG AMBITIOUS MANAGERS, DOCTORS, TRADERS, LAWYERS, AND LEADERS, AFTER OIL, THE SECOND MOST-WIDELY SOLD COMMODITY IS... COFFEE”.....

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“.... SLEEPLESS MACHISMO.... IS THE ANTITHESIS OF INTELLIGENT MANAGEMENT...”

• DITTO

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

• INSTITUTIONAL PREVENTION OF ENDANGERMENT:

•NO TO:• SMOKING

• DRINKING

• DRUGS

• SEXUAL HARASSMENT

• JUST BE “ON” PRETTY MUCH AROUND THE CLOCK - SELF-DESTRUCTION

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“IF THEY AVERAGE 4 HOURS OF SLEEP A NIGHT FOR 4-5 DAYS, THEY DEVELOP THE SAME LEVEL OF COGNITIVE IMPAIRMENT AS IF THEY’D BEEN AWAKE FOR 24 HOURS - EQUIVALENT TO LEGAL DRUNKENNESS”

• CZEISLER, C

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•SLEEPLESSNESS OR LACK OF IT:

•HEALTH HAZARD

•OCCUPATIONAL HAZARD

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•BURNOUT SYNDROME (BOS)

•STRESS DISORDERS

• EMOTIONAL EXHAUSTION

• DEPERSONALIZATION

• LACK OF PERSONAL ACCOMPLISHMENT

• FEELING OF ILL-HEALTH

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•RELATIVE INCIDENCES OF BOS

• SAUDI ARABIA (AUG ‘05) - 44-60% ORTHO/TRAUMA SURGEONS, KING FADH UNIVERSITY HOSPITAL

• SPAIN (APR ‘02) - 40-82% - PEDIA SURGEONS, HOSPITAL UNIVERSITARIO, GRANDA

• USA (OCT ‘01) - 4-32% - AMERICAN SURGEONS, ANN ARBOR, MICHIGAN

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON

TRAINING & PATIENT CARE

•“....PEOPLE WHO FAIL TO RELAX..... ARE THE PEOPLE WHO DIE EARLY....”

• LES WAAS, FOUNDER, PROCRASTINATORS’ CLUB OF AMERICA

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

• AIM:

• TO DETERMINE THE PROBABLE IMPACT OF REDUCED RESIDENTS WORK HOURS ON SURGICAL TRAINING AND PATIENT CARE IN ACCREDITED PROGRAMS AS PERCEIVED BY THEIR CHAIRPERSONS, TRAINING OFFICERS AND CHIEF RESIDENTS.

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL

TRAINING & PATIENT CARE

• OBJECTIVES

• DEFINE SURGICAL TRAINING & PATIENT CARE

• SHOW PROFILE OF RESPONDERS

• SHOW WORK HOUR PROFILE OF ACCREDITED TRAINING PROGRAMS

• SHOW PERCEIVED IMPACT ON SURGICAL TRAINING

• DEMONSTRATE PERCEIVED IMPACT ON PATIENT CARE

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE• METHODOLOGY

• NON-VALIDATED SURVEY INSTRUMENT• CHAIRMAN

• TRAINING OFFICER

• CHIEF RESIDENT

• ACCREDITED TRAINING PROGRAMS IN GENERAL SURGERY

• SEPTEMBER - NOVEMBER, 2006

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE• METHODOLOGY

• NON-VALIDATED SURVEY INSTRUMENT

• CHECK-LIST FORMAT

• 4 PARTS: 18 QUESTIONS: PROFILE, CURRENT WORK HOUR, PERCEIVED IMPACT ON SURGICAL TRAINING & PERCEIVED IMPACT ON PATIENT CARE

• TARGET RESPONDENTS: CHAIRMAN, TRAINING OFFICER, CHIEF RESIDENT

• PERCEPTIONS OF RESPONDERS ARE NOT STRATIFIED

• NO FREE-FORM COMMENTS

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE• OUTCOME MEASURES

• AVERAGE IN-HOSPITAL WORK HOURS PER WEEK

• FREQUENCY OF 24-HOUR DUTY

• T.O.-TRAINEE CONTACT TIME (MENTORSHIP)

• NUMBER & VARIETY OF CASES

• PATIENT CARE TIME (ROUNDS, OPERATING, ASSISTING)

• CONFERENCES & TEACHING ROUNDS

• RESIDENTS’ QUALITY OF LIFE

• STRESS, FAMILY & FEELING OF SATISFACTION

• ERRORS OF JUDGMENT & TECHNICAL MISTAKES

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE• LIMITATIONS

• NON-VALIDATED SURVEY INSTRUMENT

• DELIMITED TO GS PROGRAMS ONLY

• EXCLUDED JUNIOR & MEDIUM LEVEL TRAINEES

• OUTCOME ARE PERCEPTIONS (NOT OBJECTIVE PARAMETERS)

• NO CORRELATION TO OUTCOME ANALYSES

• NO CORRELATION TO PBS-RITE OUTCOME

• STRUCTURED RESPONSES (NOT AT-LIBERTY)

• ONE-TIME SURVEY (NOT AN ACTUAL LOG)

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•DEFINITION

• REDUCED RESIDENTS’ WORK HOURS - FROM CURRENT TO 80-HOUR WORK WEEK INCLUDING DUTY HOURS

• PERCEIVED IMPACT - ANTICIPATED OR FORECASTED POSITIVE AND/OR NEGATIVE EFFECTS

• SURGICAL TRAINING - CURRICULUM, TRAINEE, TRAINER, NUMBER & VARIETY OF CASES

• PATIENT CARE - QUALITY & CONTINUITY

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PCS ACCREDITED TRAINING PROGRAMS

• PSGS - 64

• PAO - 42

• AFN - 7

• PSPS - 3

• PSO-HNS - 25

• PSCRS - 2

• PUA - 11

• POA - 18

• PATACSI - 8

• PPRAS - 10

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•RESPONDERS

•123 RESPONDERS

•49 / 64 ACCREDITED GS PROGRAMS

•76.5%

REDUCED RESIDENTS’ WORK HOUR: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

•60 GOVT. INSTITUTIONS

•51 PRIVATE INSTITUTIONS

•25 UNIVERSITY-BASED HOSPITALS

•39 NON-UNIVERSITY-BASED HOSPITALS

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

• SIZE OF INSTITUTION

• < 100 BEDS 9 7.9%

• 101-300 54 47.8

• 301-400 17 15.0

• 401-600 21 18.6

• >600 12 10.6

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

•POSITION

• CHAIRMAN 40 32.5%

• TRAINING OFFICER 46 37.4

• CHIEF RESIDENT 36 29.2

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

•GENDER

•MALE 113 91.8%

•FEMALE 7 5.7

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

• YEARS IN POSITION

• < 3 YRS 70 56.9%

• 3-5 32 26.0

• > 5 21 17.0

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF RESPONDERS

•LENGTH OF GS TRAINING PROGRAM

•4 YRS 36 29.3%

•5 84 68.3

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•IN-HOSPITAL WORK HOURS PROFILE

• FREQUENCY OF 24-HOUR DUTY

Q OTHER Q 2 DAYS Q 3 DAYS ON CALL

JUNIOR 26 24 67 5

MIDDLE 19 22 70 5

SENIOR 19 27 60 3

CHIEF 24 17 52 22

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE

•PROFILE OF IN-HOSPITAL WORK HOURS

•ESTIMATED IN-HOSPITAL STAY PER WEEK:

HOURS 40 60 80 120 >120

JUNIOR 1 8 36 71 5

MIDDLE 1 8 36 72 3

SENIOR 1 5 39 67 6

CHIEF 1 4 30 51 29

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PROFILE OF IN-HOSPITAL WORK HOURS

•ESTIMATE DEDICATED HRS/WEEK FOR PATIENT CARE

HOURS 30 40 50 60 >60

JUNIOR 6 27 18 63 3

MIDDLE 6 25 21 61 3

SENIOR 6 26 19 58 3

CHIEF 6 14 26 66 3

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PROFILE OF IN-HOSPITAL WORK HOURS

•ESTIMATE HRS/WK FOR NON PATIENT CARE TASKS (RESEARCH & CONFERENCES)

HOURS 10 15 20 25 30

JUNIOR 32 42 27 2 15

MIDDLE 32 39 29 3 14

SENIOR 30 40 27 5 12

CHIEF 28 34 35 11 12

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PROFILE OF IN-HOSPITAL WORK HOURS

•ESTIMATE HRS/WK MENTORING TIME

HOURS 20 30 40 50 60

JUNIOR 71 22 18 3 6

MIDDLE 70 23 16 3 6

SENIOR 53 37 12 5 6

CHIEF 44 36 23 9 7

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPANT ON SURGICAL TRAINING & PATIENT

CARE•PERCEIVED IDEAL IN-HOSPITAL

WORK HOURS PER WEEK

HOURS 40 60 80 120 >120

JUNIOR 7 16 72 18 0

MIDDLE 7 16 72 18 0

SENIOR 7 16 67 17 1

CHIEF 4 11 63 25 6

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PERCEIVED IDEAL FREQUENCY OF

24-HOUR DUTY

FREQ/WK ONCE TWICE THRICE ON CALL

JUNIOR 0 56 59 8

MIDDLE 0 56 59 8

SENIOR 0 46 66 9

CHIEF 0 40 59 22

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PERCEIVED EFFECT ON SURGICAL

CURRICULUM

NO EFFECT 59 40.4%

REQUIRES CURRICULAR

CHANGES51 35.0

PROLONGATION OF TRAINING

PROGRAM36 24.7

REDUCED RESIDENTS’ WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PERCEIVED EFFECT ON TRAINEES

QUALITY POORER BETTER CAN’T PREDICT

SKILLS 48 72 0

KNOWLEDGE 18 95 5

ATTITUDE 29 88 1

REDUCED RESIDENTS’ WORK JOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•PERCEIVED EFFECT ON MENTORING

MORE EFFECTIVE CONTACT TIME

82

LESS EFFECTIVE CONTACT TIME

26

MORE RELIABLE EVALUATION OF PERFORMANCE

82

LESS RELIABLE EVALUATION OF PERFORMANCE

32

REDUCED RESIDENTS’ WORL HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT

CARE•SUMMARY

•MEAN IN-HOSPITAL STAY 120 HRS/WK

•FREQUENCY OF 24-HR DUTY IS 3 TIMES PER WEEK

•PROPENSITY TOWARD PERCEIVED POSITIVE IMPACT OF REDUCED RESIDENTS’ WORK HOURS ON TRAINING & PATIENT CARE

•“...THE OBSESSIVE-COMPULSIVE PERSONALITIES ARE MOST PRONE TO BURNOUT SYNDROME...”

• FRANK MINIRTH, MD & CHRIS THRUMAN, PHD, BEFORE BURNOUT BALANCE LIVING FOR BUSY PEOPLE, 1990

•“NEVER DO TODAY WHAT YOU CAN PUT OFF TILL TOMORROW”

• PAUL MEIER, MD, ADVISE TO ALL OBSESSIVE COMPULSIVES

THANK YOU