工時限制對耳鼻喉科住院醫師訓練的影響

Impacts of Duty Hour Restriction to the Otolaryngology Resident Training

尹丹桂(Tan-Kuai Wan) ； 劉得懿(Te-Yi Liu) ； 王拔群(Pa-Chun Wang)

《台灣耳鼻喉頭頸外科雜誌》 50卷2期 (2015/06) Pp. 105-113

https://doi.org/10.6286/2015.50.2.105

摘要

背景：2011年本國相繼發生住院醫師疑似過勞猝死的事件，衛生福利部在2013年5月公佈「住院醫師勞動權益保障參考指引」，頒行住院醫師工時安排合理化基準。工時限制勢必改變住院醫師的傳統訓練及工作模式，本研究利用實證醫學方法進行文獻回顧，探討工時限制對耳鼻喉科住院醫師訓練、生活品質及病人安全的影響。方法：以關鍵字「otolaryngology resident」、「work hour」及「duty hour」搜尋2003-2013英文（Pubmed）文獻，探討工時限制對耳鼻喉科住院醫師訓練、生活品質及病人照護的影響，排除非英文、評論及編輯的信等類文章。結果：搜尋到11篇相關文章；主觀研究佔82%，以問卷調查為主，顯示耳鼻喉科住院醫師普遍滿意工時限制的執行，認為能改善生活品質。反之，計劃主持人則一律持負面態度。客觀研究的結果顯示住院醫師的手術量及考試成績並無降低，病人照護品質沒有顯著變化。結論：工時限制雖然能改善住院醫師的生活品質，但訓練及病人照護品質沒有因而提昇，反而可能衍生住院醫師手術機會減少，延長訓練時間、頻繁交班增加犯錯機會等疑慮，唯目前仍缺乏較客觀的評估方法。工時限制屬重大的醫學教育政策變革，不應貿然從眾，其對耳鼻喉科住院醫師整體訓練的影響實有待更進一步的觀察。

關鍵字

耳鼻喉科 ； 住院醫師訓練 ； 工時限制

並列摘要

BACKGROUND: Resident duty hour restrictions (DHR) were introduced in 2013 by Taiwan's Ministry of Health and Welfare after a surgical resident's sudden death incident in a Tainan's medical center. The investigation speculated that fatigue might be a cause of this tragedy. Theoretically, reducing resident work hours may decrease sleep deprivation and fatigue to improve patient care; nevertheless, it is argued that such limitation comes at the expenses of prolonged resident education and safety concerns with frequent hand-over(s). Otolaryngology-head and neck surgeons work for long hours as other surgical specialties. It is not known how the DHR will impact on otolaryngology resident training in Taiwan. In this project we use the evidence-based literature review methodology to investigate the impacts of DHR to otolaryngology residents' quality-of-life, training, and patient care. METHODS: A literature review (2003-2013) was conducted (Pubmed database) using keywords ＂otolaryngology resident＂, ＂work hour restriction＂, ＂duty hour restriction＂. Articles that addressed the effect of DHR on otolaryngology resident were identified. Non-English articles, commentaries, letters to editors and editorials were excluded. RESULTS: A total of 11 articles met the inclusion criteria. These articles are classified into two categories: subjective and objective studies. Among these, 82% (N=9) were subjective studies using mainly online questionnaire survey. Results of these subjective studies showed improvement of residents' self-reported quality-of-life while no conclusion the effect of DHR on training and patient care. Survey with program directors showed a perception of worsened education quality and patient safety. CONCLUSIONS: There is no evidence to show that DHR can improve resident training, patient care, and safety. More evidences should be gathered before the implementation of a major medical education reform policy.

並列關鍵字

otolaryngology ； resident ； duty hour restriction