Resident duty hours: past, present, and future
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Résumé
Background Postgraduate medical education is founded on a tradition of service and education and is grounded in the realities of the twenty-first century. The very nature of the postgraduate enterprise is evolving in front of us all, and this is having a wide-ranging impact in a varziety of areas. At stake is both the delivery of quality patient care and the preparation of the next generation of competent physicians. The engagement of the medical profession is an essential part of this reformation. zOne of the fundamental questions facing contemporary medicine is how best to organize the work hours of physicians who are undergoing clinical training. The postgraduate medical education of the physicians we refer to as “residents” is recognized by those within and outside medicine as an enterprise dedicated to preparing new physicians to enter independent practice. It is a time of great commitment for all involved – to learning, to patient care, and to the professional development of future leaders of health care teams. It is also a period that can be experienced through a number of perspectives: that of the residents and the patients they care for, the faculty who teach them, the training programs that support their progress, the certifying bodies that ultimately endorse them for entry into practice, and the administrators in the teaching hospitals where residents learn to balance their dual roles as learners and service providers on a health care team. These perspectives differ and diverge, and they also, ultimately, lead to thze inherent tensions within residency in the modern era: education versus service, supervision versus autonomy, and quantity versus quality of care, among many others. Throughout much of the world, the hours that residents work have gradually decreased since the 1980s. This change has accelerated within the past five years with recent legislative and regulatory changes in Europe, the United States, Canada, and other jurisdictions. The question of how long residents should work has been the subject of heated discussion within the profession and among the broader public for almost three decades. The impetus for this special issue of BMC Medical Education arose from symposia on the topic of resident duty hours held at the annual International Conference on Residency Education in 2010 and 2011. These symposia, entitled respectively “Duty hours across borders” and “Solutions across borders,” took place as the most recent round of duty hour reforms were announced and implemented in the United States, the United Kingdom, and Canada, and both symposia included presentations by many of the authors of papers included in this issue. Importantly, these sessions provided an international forum to explore the challenges that can arise as a result of – and potential solutions to – changing duty hours, a dialogue we have capitalized on with this special issue.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle