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resident physician

A physician in training, after completion of medical school. An intern is a first year resident. Interns & residents staff many hospitals. Complications: - resident & intern service changes are associated with increased mortality among hospitalized patients [1] Notes: - dissatisfaction with flexible hours [2] - little time spent in direct patient care for all trainees (suggesting extended amounts of time engaging with EMRs) [2] - greater inpatient attending supervision may lead to decreased autonomy in resident decision-making without improving patient safety [3] - flexible vs standard hours resulted in similar patient-safety & trainee-restfulness outcomes [4]

General

physician

References

  1. Denson JL, Jensen A, Saag HS et al Association Between End-of-Rotation Resident Transition in Care and Mortality Among Hospitalized Patients. JAMA. 2016;316(21):2204-2213 PMID: 27923090 http://jamanetwork.com/journals/jama/article-abstract/2589342 - Arora VM, Farnan JM Inpatient Service Change: Safety or Selection? JAMA. 2016;316(21):2193-2194 PMID: 27923077 http://jamanetwork.com/journals/jama/article-abstract/2589329
  2. Desai SV, Asch DA, Bellini LM et al. Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med 2018 Mar 20; PMID: 29557719 Free Article http://www.nejm.org/doi/10.1056/NEJMoa1800965 - McMahon GT. Managing the most precious resource in medicine. N Engl J Med 2018 Mar 20; PMID: 29557706 Free Article http://www.nejm.org/doi/10.1056/NEJMe1802899
  3. Finn KM, Metlay JP, Chang Y, et al. Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial. JAMA Intern Med. 2018 Jun 4 PMID: 29868877 https://psnet.ahrq.gov/resources/resource/32197
  4. Basner M, Asch DA, Shea JA et al. Sleep and alertness in a duty-hour flexibility trial in internal medicine. N Engl J Med 2019 Mar 7; 380:915-923. PMID: 3085574 https://www.nejm.org/doi/10.1056/NEJMoa1810641 - Silber JN, Bellini LM, Shea JA et al. Patient safety outcomes under flexible and standard resident duty-hour rules. N Engl J Med 2019 Mar 7; 380:905-914. PMID: 30855740 https://www.nejm.org/doi/10.1056/NEJMoa1810642 - Rosenbaum L, Lamas D. Eyes wide open - Examining the data on duty-hour reform. N Engl J Med 2019 Mar 7; 380:969-970. PMID: 30855748 https://www.nejm.org/doi/10.1056/NEJMe1817497