Background

Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians.

Methods

We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores.

Results

There were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees’ perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by program directors and faculty of whether trainees’ workload exceeded their capacity (primary outcome for faculty satisfaction with education; response rate, 90%). Another survey of interns (response rate, 49%) revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality (odds ratio, 1.67; 95% confidence interval [CI], 1.02 to 2.73) and overall well-being (odds ratio, 2.47; 95% CI, 1.67 to 3.65). In contrast, directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching (response rate, 98%; odds ratio, 0.13; 95% CI, 0.03 to 0.49). Average scores (percent correct answers) on in-training examinations were 68.9% in flexible programs and 69.4% in standard programs; the difference did not meet the noninferiority margin of 2 percentage points (difference, −0.43; 95% CI, −2.38 to 1.52; P=0.06 for noninferiority).

Conclusions

There was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies. Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs, but program directors were more satisfied. (Funded by the National Heart, Lung, and Blood Institute and the ACGME; iCOMPARE ClinicalTrials.gov number, NCT02274818.)

中文翻译：

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内科医学的时空灵活性试验中的教育成果

背景

持续存在的担忧是，医疗住院计划中不灵活的工作时间规则可能会对医师的培训产生不利影响。

方法

我们在美国随机分配了63种内部医学住院医师课程，这些课程由2011年研究生医学教育认证委员会（ACGME）的标准工作时间政策或未指定轮班时间限制或强制性休假的更灵活政策来管理轮班之间。教育经验的衡量标准包括对实习生（一年级居民）活动的观察，对受训者（实习生和居民）和教职员工的调查以及实习考试成绩。

结果

实习生在直接患者护理和教育中所花费的平均时间百分比，以及受训者对临床需求和教育之间的适当平衡的看法方面，均没有显着的组间差异（受训者对教育满意度的主要结果；回应率，91）百分比或计划主任和教职员工对受训人员的工作量是否超出其能力的评估（教职员工对教育的满意度为主要结果；回应率为90％）。另一项对实习生的调查（回应率为49％）显示，采用弹性计划的学员更有可能报告对培训多个方面的不满意，包括教育质量（赔率，1.67； 95％的置信区间[CI]，1.02至2.73）和整体健康状况（赔率，2.47； 95％CI，1.67至3.65）。相比之下，弹性课程的主任不太可能报告对多种教育过程的不满意，包括在床边上课的时间（回应率98％；优势比0.13； 95％CI 0.03至0.49）。弹性课程的考试中平均分数（正确答案的百分比）为68.9％，标准课程为69.4％。差异未达到2个百分点的非劣效性差（差异为-0.43； 95％CI为-2.38至1.52；非劣效性为P = 0.06）。

结论

具有标准工作时间政策的计划与具有更灵活政策的计划之间，医学实习生花费在直接病人护理和教育上的时间比例没有显着差异。灵活计划的实习生对教育经历的满意度不如标准计划的实习生满意，但计划主管则更满意。（由美国国家心肺血液研究所和ACGME资助； iCOMPARE ClinicalTrials.gov编号，NCT02274818。）