Use of a PDA to Monitor Surgery Student Work and Sleep Hours Susan Steinemann, MD, FACS Jill Omori,...
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Transcript of Use of a PDA to Monitor Surgery Student Work and Sleep Hours Susan Steinemann, MD, FACS Jill Omori,...
![Page 1: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/1.jpg)
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
![Page 2: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/2.jpg)
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”
![Page 3: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/3.jpg)
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?
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U Hawaii Work Hours Policy
Developed Fall 2003
Guidelines specifyAverage <80 hours/wkLeave early post-callEliminate non-
educational activities1 day/week off
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Faculty and residents were advised of the work hours policy
Students were encouraged to report transgressions
Students rarely reported noncompliance (….. to US)
![Page 6: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/6.jpg)
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
![Page 7: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/7.jpg)
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
![Page 8: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/8.jpg)
Logs reviewed
Identify transgressions from work hours policy
Correlate logged work hours withEstimated work hoursSleep hoursNBME subject exam scoreClinical evaluation by faculty
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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
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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
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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
![Page 12: 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.](https://reader036.fdocuments.us/reader036/viewer/2022062511/551a97e05503466b3a8b527b/html5/thumbnails/12.jpg)
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
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NBME Subject Exam Scores
No significant correlation with work hours
Trend toward positive correlation with more sleep (r=0.25)
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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
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Clinical Evaluations Directly Correlated with Work Hours
HOURS WORKED
HONORS NOT HONORS
>75 8 3
<75 3 9
*P<.05 Fisher’s Exact Test
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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
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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
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Get it as it happens
Be aware.. the pitfalls of overextension