Upload
kyree-latson
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
Use of a PDA to Monitor Surgery Student Work and Sleep Hours
Susan Steinemann, MD, FACS
Jill Omori, MD
University of Hawaii School of Medicine
TOP 10 SIGNS YOU’VE BEEN IN SURGICAL EDUCATION TOO
LONG….
10. You never argue…..you exchange summative and formative comments
9. Your girlfriend gets a Needs Assessment instead of foreplay
8. Your toddler was potty trained by cognitive task analysis
7. Your statistics may be rusty, but you know dozens of ways to achieve a sum of “80”
Medical Student Work Hours
LCME Guidelines, Feb 2004Duty hours should be setNot longer than residents
26% of medical schools had written work hours policy in 2003-4
LCME Part II survey
Monitored? Enforced?
U Hawaii Work Hours Policy
Developed Fall 2003
Guidelines specifyAverage <80 hours/wkLeave early post-callEliminate non-
educational activities1 day/week off
Faculty and residents were advised of the work hours policy
Students were encouraged to report transgressions
Students rarely reported noncompliance (….. to US)
Pilot study using PDA to record work hours data
September 2004 – March 20057 consecutive days in mid-point of clerkshipHanDBase softwareStudents logged real-time work and sleep hours
Work hours log
Activities performed during work hours categorized and logged in 15-minute increments
Noted if they “would have left” if their presence was not expected or required
All sleep hours (home & work) logged
Logs reviewed
Identify transgressions from work hours policy
Correlate logged work hours withEstimated work hoursSleep hoursNBME subject exam scoreClinical evaluation by faculty
All students successfully collected work hours data
Better compliance than with patient logs3 of 35 students
failed to log sleep hours at home
Only positive comments about PDA log system
Transgressions from Work Hour Policy
24 students (69%) deviated from the written work hour policy12 students worked >80 hours17 students worked late post-call
49% of students reported non-educational activitiesNo two students reported the same activity
on the same day
Estimated vs. logged work hours
Mean work hours = 73 (range 41-99)Estimated work hours ranged from 60-110Estimated hours did not correlate well with logged hours (r=0.19)63% of students overestimated work hoursMedian overestimated time was 19 hours/week
SleepAverage sleep over 7 days ranged from 3.9-8.25 hours / 24-hour period
(median 5.5 hrs)
No significant
correlation
with work
hours
NBME Subject Exam Scores
No significant correlation with work hours
Trend toward positive correlation with more sleep (r=0.25)
NBME Scores: Effects of more work and less sleep
HOURS WORKED/ HOURS SLEPT
n MEAN NBME EXAM SCORE
NATIONAL PERCENTILE RANK
80 work AND
<5.5 sleep
7 66.6* 40th %
<80 and/or
5.5
23 72.7* 70th %
*p<.05 by t-test
Clinical Evaluations Directly Correlated with Work Hours
HOURS WORKED
HONORS NOT HONORS
>75 8 3
<75 3 9
*P<.05 Fisher’s Exact Test
Conclusions
Students’ estimated work hours may be inaccurate
PDA may be a useful tool to monitor work hours
Sleep deprivation common, may not improve with work hour limitations
Students who spend more time at the hospital….
And who get less sleep (<5.5 hours/day) have lower scores on standardized written examinations of knowledgeReceive higher ratings
of their knowledge and clinical skills by faculty surgeons
Get it as it happens
Be aware.. the pitfalls of overextension