Author Interviews, Education, JAMA, Outcomes & Safety / 09.12.2016
End of Resident Rotation May Be Risky Time For Hospitalized Patients
MedicalResearch.com Interview with:
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Dr. Joshua Denson[/caption]
Joshua L Denson MD
Pulmonary and Critical Care Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Miscommunication during physician transition in care has been associated with adverse patient events and medical errors; however, an understudied topic is the transition in care that occurs each month when resident physicians switch clinical rotations, also called an end-of-rotation transition. During this handoff, hospitalized patients (up to 10-20) are handed over to an oncoming physician who has never met the patients. We sought to investigate if this type of transition was associated with worse patient outcomes, specifically mortality.
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations limited first-year resident physicians (interns) to 16 continuous hours of work. Although these rules do not appear to have affected overall patient safety outcomes, they have been associated with an increase in shift-to-shift handoffs among training physicians. Given this, we wanted to study how they might impact patient outcomes surrounding end-of-rotation transitions in care.
Dr. Joshua Denson[/caption]
Joshua L Denson MD
Pulmonary and Critical Care Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Miscommunication during physician transition in care has been associated with adverse patient events and medical errors; however, an understudied topic is the transition in care that occurs each month when resident physicians switch clinical rotations, also called an end-of-rotation transition. During this handoff, hospitalized patients (up to 10-20) are handed over to an oncoming physician who has never met the patients. We sought to investigate if this type of transition was associated with worse patient outcomes, specifically mortality.
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations limited first-year resident physicians (interns) to 16 continuous hours of work. Although these rules do not appear to have affected overall patient safety outcomes, they have been associated with an increase in shift-to-shift handoffs among training physicians. Given this, we wanted to study how they might impact patient outcomes surrounding end-of-rotation transitions in care.
Dr. Douglas A. Mata Harvard Medical School[/caption]
Douglas A. Mata, M.D., M.P.H.
Anatomic and Clinical Pathology
Resident Physician, Brigham & Women’s Hospital
Clinical Fellow, Harvard Medical School
Boston, MA 02115
Marco A. Ramos, M.Phil., M.S.Ed.
History of Science and Medicine
M.D./Ph.D. Candidate, Yale School of Medicine
New Haven, CT 06511
Medical Research: What is the background for your study?
Dr. Mata: Training to be a doctor is clearly stressful, but the prevalence of depression among trainees is not well known. They may get especially depressed during their grueling years of residency, when young physicians are learning their craft by working long hours and taking care of critically ill patients. Coming up with a reliable estimate of the prevalence of depression among graduate medical trainees would help us identify causes of resident depression and begin to treat or prevent it. We thus aimed to find answers to two questions:
Dr. Sondheimer[/caption]
MedicalResearch.com Interview with:
Henry Sondheimer, MD
Senior director of student affairs
American Association of Medical Colleges
Medical Research: What is the background for this study? What are the main findings?
Dr. Sondheimer: The background for this study in JAMA's Med Ed issue of December 8th is that a group of the medical schools' deans asked us (AAMC staff) in 2014 whether there was a differential in placement of African-American, Hispanic, and Native American graduates into Graduate Medical Education at the time of their graduation from medical school. In fact, as shown in this short paper, there is a difference with more current graduates from the under-represented in medicine graduates not beginning their GME immediately post-graduation. However, over time this difference diminishes substantially but does not disappear completely.
Dr. David Ouyang[/caption]
MedicalResearch.com Interview with:
David Ouyang MD
Department of Internal Medicine
Stanford University School of Medicine
Stanford, California
Medical Research: What is the background for this study? What are the main findings?
Dr. Ouyang: In American teaching hospitals, trainee resident physicians are an integral part of the medical team in performing procedures, writing notes, and coordinating care. As more care is being facilitated by electronic medical record (EMR) systems, we are just now finally able to understand how much residents work and how residents spend their time. In our study, we examined the types and timing of electronic actions performed on the EMR system by residents and found that residents spend about a third (36%) of their day in front of the computer and frequently perform many simultaneous tasks across the charts of multiple patients. Additionally, residents often do work long hours, with a median of 69.2 hours per week when on the inpatient medicine service.
