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Médecine du travail du personnel hospitalier

A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes

Auteur     Najma Ahmed
Auteur     Katharine S. Devitt
Auteur     Itay Keshet
Auteur     Jonathan Spicer
Auteur     Kevin Imrie
Auteur     Liane Feldman
Auteur     Jonathan Cools-Lartigue
Auteur     Ahmed Kayssi
Auteur     Nir Lipsman
Auteur     Maryam Elmi
Auteur     Abhaya V. Kulkarni
Auteur     Chris Parshuram
Auteur     Todd Mainprize
Auteur     Richard J. Warren
Auteur     Paola Fata
Auteur     M. Sean Gorman
Auteur     Stan Feinberg
Auteur     James Rutka
Volume     259
Numéro     6
Pages     1041-1053
Publication     Annals of Surgery
Date     Jun 2014
Résumé     BACKGROUND: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. METHODS: A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. RESULTS: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. CONCLUSIONS: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.

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doi:10.1097/SLA.0000000000000595

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