The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions.

BACKGROUND: To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes. METHODS: A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions. RESULTS: The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions. CONCLUSION: With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements.

A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center.

BACKGROUND: The Accreditation Council for Graduate Medical Education's (ACGME) new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. METHODS: Residents and faculty (1330) in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. RESULTS: Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. CONCLUSION: Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function.

Barriers to innovation in continuing medical education.

INTRODUCTION: Criteria for maintenance of certification (MOC) emphasize the importance of competencies such as communication, professionalism, systems-based care, and practice performance in addition to medical knowledge. Success of this new competency paradigm is dependent on physicians' willingness to engage in activities that focus on less traditional competencies. We undertook this analysis to determine whether physicians' preferences for CME are barriers to participation in innovative programs. METHODS: A geographically stratified, random sample of 755 licensed, practicing physicians in the state of Oregon were surveyed regarding their preferences for type of CME offering and instructional method and plans to recertify. RESULTS: Three hundred seventy-six of 755 surveys were returned for +/-5% margin of error at 95% confidence level; 91% of respondents were board certified. Traditional types of CME offerings and instructional methods were preferred by the majority of physicians. Academic physicians were less likely than clinical physicians to prefer nontraditional types of CME offerings and instructional methods. Multiple regression analyses did not reveal any significant differences based on demography, practice location, or physician practice type. DISCUSSION: Physicians who participate in CME select educational opportunities that appeal to them. There is little attraction to competency-based educational activities despite their requirement for MOC. The apparent disparity between the instructional methods a learner prefers and those that are the most effective in changing physician behavior may represent a barrier to participating in more innovative CME offerings and instructional methods. These findings are important for medical educators and CME program planners developing programs that integrate studied and effective educational methods into CME programs that are attractive to physicians.