The Effects of Duty Hours Reform on Internal Medicine: Views from Different Levels of Practicing Medicine and Changes in Milestones Assessment Outcomes

Chiung-Yu Chen ； Jhong-Han Wu ； Wei-Hung Lin ； Kai-Wen Nien ； Pei-Jen Tsai ； Huei-Ting Wang ； Hsiao-Ju Lin

《Journal of Medical Education》 25卷1期 (2021/03) Pp. 24-34

https://doi.org/10.6145/jme.202103_25(1).0002

摘要

Purpose: We aim to elicit views from individuals at different levels of a medical hierarchy on the effects of the dury hour reform (DHR) on medical education and patient care. We also address the changes in the summative assessment of learning outcomes after the DHR. Methods: We conducted surveys of attending physicians from the Department of Internal Medicine, postgraduate year (PGY) residents, and clerks. Rates of prolonged hospitalization ＞ 30 days, 2-week readmissions, and revisits to the emergency room within 3 days of discharge before and after the DHR were checked. The subcompetence levels of reporting milestones of PGY residents before and after the DHR were compared. Results: More than half of the attending physicians were concerned about declines in the residents' development of skill (66.7%), knowledge (55.6%), and overall achievement (63%). However, none of the PGY residents considered the DHR to have a negative impact on learning. There were no significant declines in the perceptions of medical students on residents' teaching performance after the DHR or on the rates of readmission, emergency room revisits, and prolonged hospitalization. Significantly lower levels of milestones assessment scores in 17 out of 22 subcompetencies were noted after the DHR. Conclusions: A DHR has no significant impact on inpatient care and clerk education. Different from the perceptions of residents, both the assessments of milestones and the perceptions of attending physicians indicated a decline in learning outcomes after the DHR.

關鍵字

duty hour reform ； internal medicine ； reporting milestones

參考文獻

Lin JU, Wu JH, Lu CY, et al.: The Implementation of ACGME “Reporting Milestones” in Internal Medicine Postgraduate Year Training Program – Experience Sharing and Preliminary Outcome. J Med Education 2020;24:161-72.

Nasca TJ, Day SH, Amis ES, et al.: The New Recommendations on Duty Hours from the ACGME Task Force. N Engl J Med 2010;363:e3.

Kogan JR, Lapin J, Aagaard E, et al.: The Effect of Resident Duty-Hours Restrictions on Internal Medicine Clerkship Experiences: Surveys of Medical Students and Clerkship directors. Teach Learn Med 2015;27:37-50.

Desai SV, Asch DA, Bellini LM, et al.: Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine. N Engl J Med 2018;378:1494-508.

Silber JH, Bellini LM, Shea JA, et al.: Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules. N Engl J Med 2019;380:905-14.