The Swedish duty hour enigma

BMC Medical Education

Research Article

Hanna Frydén¹  Jonas Nordquist¹  Kristina Sundberg¹  Lars Kihlström² 

[1] Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden;Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden;Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden;Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden;

关键词: Social Contract;    Residency Training;    Resident Education;    Independent Practice;    Contextual Framework;   

DOI  :  10.1186/1472-6920-14-S1-S6

来源: Springer

【 摘 要 】

BackgroundThe Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this “the Swedish duty hour enigma.” This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions?MethodsA case study was conducted at Karolinska University Hospital, Stockholm – an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research.ResultsThe residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility.ConclusionsAccording to Swedish residents’ conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice.

【 授权许可】

CC BY   
© Sundberg et al; licensee BioMed Central Ltd. 2014