To Stay or Not to Stay? A Grounded Theory Study of Residents’ Postcall Behaviors and Their Rationalizations for Those Behaviors
Bibliographic record
Abstract
PURPOSE: Although policies to restrict residents' duty hours are pervasive, resident adherence to restricted duty hours has proved challenging. The authors sought to describe residents' postcall behaviors and understand the dominant rationalizations underpinning their decisions to stay or not to stay after a 24-hour shift. METHOD: Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 24 residents across six surgical and nonsurgical specialty programs at one Canadian institution during 2012. They analyzed transcripts iteratively using a constant comparative method of identifying and refining key themes as the data set accrued, and theoretically sampling until theme saturation. RESULTS: Abiding by cultural norms was the dominant rationalization for both choosing to continue to work postcall or to go home. Cutting across this dominant theme were three subcategories (infrastructure, invoking values, and negotiating tension) with a pattern of residents invoking similar values of patient safety and education regardless of the cultural norms of their program, the infrastructure within which they worked, or the tensions they were navigating. CONCLUSIONS: Although central to residents' rationalizations, values appear to be versatile, amenable to multiple, even conflicting, applications. Residents perceived that they were upholding the values of patient safety and education regardless of which postcall behavior they chose-staying or going. Based on this, for duty hours reform initiatives to be successful, a shift to emphasizing organizational changes will be required to reduce the circumstances in which postcall behavior is an individual, values-based decision.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.007 | 0.013 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".