Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: systematic review
Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome.Design Systematic review.Data sources Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were s...
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Published in | BMJ Vol. 342; no. 7800; p. 747 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
England
British Medical Journal Publishing Group
22.03.2011
BMJ Publishing Group BMJ Publishing Group LTD |
Subjects | |
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Abstract | Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome.Design Systematic review.Data sources Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles.Study selection Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion.Results 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made.Conclusions Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours’ legislation on objective educational and clinical outcomes. |
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AbstractList | OBJECTIVESTo determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome.DESIGNSystematic review.DATA SOURCESMedline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles.STUDY SELECTIONStudies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion.RESULTS72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made.CONCLUSIONSReducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes. Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Design Systematic review. Data sources Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Study selection Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. Results 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Conclusions Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours’ legislation on objective educational and clinical outcomes. STUDY QUESTION What is the impact of a reduction in working hours of doctors in postgraduate medical training on objective measures of educational and clinical outcome? SUMMARY ANSWER Reducing working hours to less than 80 a week has not adversely affected patients' outcomes or postgraduate training in the United States. The impact of reducing hours to less than 56 or 48 a week in the United Kingdom has not yet been sufficiently evaluated in high quality studies. WHAT IS KNOWN AND WHATTHIS PAPER ADDS Legislation limiting duty hours is aimed at improving doctors' working conditions and patient safety; however, concerns have been raised over potential unintended adverse consequences for training standards and patient outcomes. Reductions in working hours do not seem to have had an adverse effect on objective outcomes in patients or postgraduate training. To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Systematic review. Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes. OBJECTIVE:s To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Design Systematic review. DATA SOURCES: Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. STUDY SELECTION: Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. RESULTS: 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. CONCLUSIONS: Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes. |
Author | Moonesinghe, S R Shahi, N Beard, J D Lowery, J Millen, A |
Author_xml | – sequence: 1 givenname: S R surname: Moonesinghe fullname: Moonesinghe, S R email: ramani.moonesinghe@uclh.nhs.uk organization: Department of Surgery, Northern General Hospital, Sheffield S5 7AU – sequence: 2 givenname: J surname: Lowery fullname: Lowery, J email: ramani.moonesinghe@uclh.nhs.uk organization: Department of Surgery, Northern General Hospital, Sheffield S5 7AU – sequence: 3 givenname: N surname: Shahi fullname: Shahi, N email: ramani.moonesinghe@uclh.nhs.uk organization: Department of Surgery, Northern General Hospital, Sheffield S5 7AU – sequence: 4 givenname: A surname: Millen fullname: Millen, A email: ramani.moonesinghe@uclh.nhs.uk organization: Department of Surgery, Northern General Hospital, Sheffield S5 7AU – sequence: 5 givenname: J D surname: Beard fullname: Beard, J D email: ramani.moonesinghe@uclh.nhs.uk organization: Department of Surgery, Northern General Hospital, Sheffield S5 7AU |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/21427046$$D View this record in MEDLINE/PubMed |
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Copyright | Moonesinghe et al 2011 BMJ Publishing Group Ltd 2011 Copyright: 2011 © Moonesinghe et al 2011 |
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Snippet | Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical... STUDY QUESTION What is the impact of a reduction in working hours of doctors in postgraduate medical training on objective measures of educational and clinical... To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and... OBJECTIVE:s To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical... OBJECTIVESTo determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical... |
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Title | Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: systematic review |
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