Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies. (November 2016)

• Record Type: Journal Article
• Authors: Coverdill, James E.; Alseidi, Adnan; Borgstrom, David C.; Dent, Daniel L.; Dumire, Russell D.; Fryer, Jonathan; Hartranft, Thomas H.; Holsten, Steven B.; Nelson, M. Timothy; Shabahang, Mohsen; Sherman, Stanley; Termuhlen, Paula M.; Woods, Randy J.; Mellinger, John D.
• Is Part Of: Academic medicine. Volume 91:(2016)Supplement
• Publication Date: 2016-11
• Subjects: Medical education -- Periodicals; Medical policy -- Periodicals; Medical personnel -- Periodicals; Periodicals; 610.711
• DOI: 10.1097/ACM.0000000000001358
• Languages: English
• ISSNs: 1040-2446

Abstract

Abstract : Purpose: Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. Method: Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. Results: A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. Conclusions: Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.