Dr Shock MD PhD

Why it is a bad idea? Because they become more dominant and less patient centered the next day in their patient care especially in the afternoon as analysed from recordings on autiotapes.
By the end of an afternoon clinic session, residents who had stayed late reported feeling more distracted, less competent and less succesfull compared to those who had left on time. Even when compared with the residents who were on call. Moreover the residents that stay late feel less fulfilled than those who don't stay late.

Possible motives for residents to stay late at the hosipital:

• Residents may lack adequate time-management skills


• Residents may stay late voluntarily because they think they can learn more


• Residents may feel responsible for their patients


• Some residents work less efficiently than others


• Residents may have difficulty in trusting others to take over patient care


• Some residents may use the hospital as a place to fulfil social and emotional needs

Limiting on long working hours may not necessarily reduce residents' time on the job. Limits on consecutive hours as expressed in the work guidelines issued by the Accreditation Council of Graduate Medical Education (ACGME) in 2003 makes it difficult to collect data about the hours that residents actually work. The researchers used data collected in 1990 to study "staying late". At that time residents were free to report on the time they spentat the hospital or in the clinic.

How?
Analysis of a systematic sample of 243 primary care visits conducted in 1990 by 52 paediatric residents at a teaching hospital. They reported about their work responsibilities the night before each primary care visit and their communication style was analysed from recordings made on audioptapes.

Limitations
1. Old data, the experience of current residents may differ.
2. Little knowledge about what residents did when staying late, whether staying late was habitual or sporadic.


Solution
Helping residents to learn to manage their work while under clinical stress. This could promote better adherence to guidelines on working hours and have a positive impact on patient care.

Article Discussed:
Chen-Chung Liu, Lawrence S Wissow (2008)
Residents who stay late at hospital and how they perform the following day
Medical Education 42 (1), 74–81.
doi:10.1111/j.1365-2923.2007.02899.x

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