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Journal Article > Study
Sexton JB, Thomas EJ, Helmreich RL. BMJ. 2000;320:745-749.
This study describes self-reported perceptions of teamwork among operating room and intensive care unit staff as well as those of an airline cockpit crew. In the medical setting, investigators discovered tremendous variation in teamwork perceptions that followed traditional hierarchies. While surgical attendings and residents rated teamwork high, anesthesiology attendings rated it lower, as did surgical nurses and anesthesia residents in decreasing order. The authors also note that discussing errors seems to be a greater challenge in medicine than in aviation, which may derive from the fact that aviation participants acknowledged that fatigue and stress negatively impact job performance. While the findings draw only from survey results and make no connection to actual errors in practice, they do generate support for a safety culture in medicine similar to that of the aviation field.
Journal Article > Commentary
Nasca TJ, Day SH, Amis ES Jr; for ACGME Duty Hours Task Force. N Engl J Med. 2010;363:e3.
This article summarizes the Accreditation Council for Graduate Medical Education's proposed new regulations on housestaff duty hours. The recommendations are perhaps most notable for what they do not contain—a reduction in the 80-hour weekly limit. Rather than narrowly focusing on duty-hour restrictions, the recommendations take a broad approach to maximizing patient safety in training environments through targeted reductions in work hours for first-year residents, enhanced supervision by attending physicians, standardizing expectations around handoffs and signouts, and engaging residents in safety and quality improvement efforts. Although the current 80-hour work week will be preserved, the new regulations would eliminate extended-duration shifts for first-year residents (as was recommended in a 2008 Institute of Medicine report). The current regulations, implemented in 2003, have improved residents' quality of life but have not positively impacted patient safety or educational outcomes. The ACGME acknowledged this evidence in crafting recommendations that seek to establish a culture of safety within residency programs and focus more broadly on enhancing supervision for early-stage residents while allowing more autonomy for senior trainees.
Journal Article > Commentary
Montgomery A. Burnout Res. 2014;1:50-56.
Many health care professionals exhibit symptoms of burnout, and national studies have shown that approximately one-third of practicing physicians and nurses display hallmark symptoms of emotional exhaustion and diminished sense of personal accomplishment. This commentary explores how medical schools, organizational culture, and working while sick can contribute to physician burnout. The author advocates for a systematic bottom-up approach to address the problem.