20 de mayo de 2013

Percepción de los residentes de cirugía sobre la restricción de horas de trabajo en Estados Unidos

Existe una gran controversia sobre la cantidad de horas que debentrabajar los residentes. Debe ser suficiente para su formación y equilibrada para tener la opción de una vida personal satisfactoria. El caso de las especialidades quirúrgicas es diferente en comparación con las especialidades médicas. Una aproximación más objetiva sobre el resultado de estas medidas tomadas en Estados Unidos, refleja que hay cierta falta de aceptación. Realmente necesitamos más horas para nuestra formación?

Surgical Residents' Perceptions of 2011 Accreditation Council for Graduate Medical Education Duty Hour Regulations

JAMA Surg. 2013;148(5):427-433

Importance: In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.

Objective: To examine surgical residents' views of the 2011 ACGME Common Program requirements after implementation in July 2011.

Design: A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.

Setting: ACGME-accredited teaching hospitals in the United States and US territories.

Participants: The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.

Main Outcomes and Measures: Residents' perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.

Results: A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).

Conclusions and Relevance: A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions—improved education, patient care, and quality of life—have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.