TY - JOUR
T1 - Resistance to change in surgical residency
T2 - An ethnographic study of work hours reform
AU - Kellogg, Katherine C.
AU - Breen, Elizabeth
AU - Ferzoco, Stephen J.
AU - Zinner, Michael J.
AU - Ashley, Stanley W.
N1 - Funding Information:
This work was supported by funds from the MIT Workplace Center.
PY - 2006/4
Y1 - 2006/4
N2 - BACKGROUND: Although the practical challenges to work hour restrictions have been the focus of much discussion, cultural resistance to such change has received less attention. Surgical residency has its own unique social structure, and we hypothesized that challenges to this would provide impediments to successful implementation of duty hours reform. STUDY DESIGN: We used ethnographic research methods to study the efforts at work hour restriction over a 15-month period before the introduction of the Accreditation Council for Graduate Medical Education regulations. These methods, validated for studying institutional change, build on intense periods of observation. Records of observations are then analyzed and coded to uncover cultural and political challenges. The frequency of successful hand-offs in sign-out situations between day and night float residents was measured as an objective index of success. RESULTS: Practical issues were addressed initially by scheduling adjustments including creating a night float system. The hand-offs that this system required, however, were successful only 14% of the time. Subsequent steps to address the challenge to resident identity by top-down support of a new definition of professionalism increased the number of successful hand-offs to 39%. Finally, a reduction in a noted hierarchy violation led to successful hand-offs 79% of the time. CONCLUSIONS: These results demonstrate that practical solutions alone may not be a sufficient basis for change in surgical residency. While we face other challenges to the traditional surgical culture, attention to social and political issues may enhance the success of our efforts.
AB - BACKGROUND: Although the practical challenges to work hour restrictions have been the focus of much discussion, cultural resistance to such change has received less attention. Surgical residency has its own unique social structure, and we hypothesized that challenges to this would provide impediments to successful implementation of duty hours reform. STUDY DESIGN: We used ethnographic research methods to study the efforts at work hour restriction over a 15-month period before the introduction of the Accreditation Council for Graduate Medical Education regulations. These methods, validated for studying institutional change, build on intense periods of observation. Records of observations are then analyzed and coded to uncover cultural and political challenges. The frequency of successful hand-offs in sign-out situations between day and night float residents was measured as an objective index of success. RESULTS: Practical issues were addressed initially by scheduling adjustments including creating a night float system. The hand-offs that this system required, however, were successful only 14% of the time. Subsequent steps to address the challenge to resident identity by top-down support of a new definition of professionalism increased the number of successful hand-offs to 39%. Finally, a reduction in a noted hierarchy violation led to successful hand-offs 79% of the time. CONCLUSIONS: These results demonstrate that practical solutions alone may not be a sufficient basis for change in surgical residency. While we face other challenges to the traditional surgical culture, attention to social and political issues may enhance the success of our efforts.
UR - http://www.scopus.com/inward/record.url?scp=33645295734&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33645295734&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2005.11.024
DO - 10.1016/j.jamcollsurg.2005.11.024
M3 - Article
C2 - 16571434
AN - SCOPUS:33645295734
SN - 1072-7515
VL - 202
SP - 630
EP - 636
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -