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2008-2009 On Call Schedule
Surgery Resident Work Hour and Environmental Initiatives
Prompted by recent attention to declining interest in surgical careers and in
particular, resident work hours, the University of Louisville Department of
Surgery endorsed comprehensive restructuring of resident work hours and the
entire working environment. Our Department of Surgery has taken the lead in
adopting a global decrease in work hours while maintaining a rich surgical
experience tempered with a strong didactic program.
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A recent national symposium on the status of surgical residency training hosted
by our Department (1) addressed fundamental issues surrounding the decline in
quantity and quality of surgical applicants. Stemming from these discussions,
the chief administrative residents in concert with junior house staff and
faculty led an initiative to enhance surgical resident lifestyle by maximizing
the much needed "out of hospital" experience. Following guidelines set forth by
the ACGME and incorporating anticipated regulations, we have addressed three
fundamental areas within this program to enhance the surgery resident's
lifestyle. They are mandatory conferences, in-house call, and unrestricted time
off.
This initiative has been lead by reorganizing the basic teaching conference
schedule. This aspect of program restructuring was designed to incorporate
conference time into the traditional work week, freeing up valuable weekend
hours. The most significant and successful change has been the move of Saturday
morning Grand Rounds and Resident's Conference to Friday mornings. This has
provided the opportunity for weekend time off for study as well as quality time
spent with family and significant others.
In house call is usually the most significant burden for the surgical resident.
The Department of Surgery has led a transition over the past two years to
eliminate every other day call. The most recent rotation to change this status
has been the Trauma Service at University Hospital. UofL has a rich tradition
in trauma service to the surrounding states as well as providing a strong
foundation to surgical training. This continues with enhanced attending and
fellow support while maintaining the highest caliber of training and
independent work for the residents. In order to eliminate every other night
call the Elective Surgery Team takes call for Trauma two nights a week
providing much needed relief for the primary teams. In exchange for their
services, the Trauma team takes all inhouse call for the Elective team,
effectively eliminating the traditional in house call. This has been an
overwhelming success from day one. All other services maintain in-house call
for junior residents every third to fourth night (Table 1).
Time away from the hospital has taken many forms in the new program. Post-call
residents are no longer required to remain n the hospital after a night of
call. Post-call residents leave the hospital after AM rounds (8:00 am). This
gives a much needed re-charge time with greater than 12 hours off between
shifts. Junior house staff receives at least one day a week off, free of
resident responsibility. Chief residents, who are often overlooked, now get
every other weekend off on most services, notably the Norton private service,
and continue to take home call for all services other than Trauma. As a result,
we have made great progress to a 80 hour resident work week.
Minimizing the resident work hours while maintaining a strong educational
experience has been the goal of this Department. All of these changes have lead
to increased resident morale, enhanced productivity and a better learning
environment. All services now average less than 80 hours a week with more time
out of the hospital. The future will bring more support staff, including nurse
practitioners, to reduce resident work load shifting surgery residents away
from the Dictaphone to the operating room and patient's bedside. This continues
to be a dynamic process, evolving to promote healthy and safe work environment
for surgical training.
Suggestions for Further Reading:
1. Polk HC. The declining interest in surgical careers, the primary care
mirage, and concerns about contemporary undergraduate surgical education. Am J
Surg (United States), Sep 1999, 178(3) p177-9
2. American Journal of Surgery, Sep 2002, 184(3).
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