short report Wien Klin Wochenschr (2018) 130:404–407 https://doi.org/10.1007/s00508-018-1340-1 Survey results Konstantin D. Bergmeister · Martin Aman · Bruno K. Podesser Published online: 27 April 2018 © The Author(s) 2018 Summary all, 28.85% thought that restricted working hours can Background New regulations for working hours of positively inﬂuence education, while 19.04% thought medical doctors have been implemented in Austria the opposite and 52.11% were undecided. based on the European directive 2003/88/EG, limiting Discussion Considering the limited available time and on-duty working hours to 48 h per week. Clinical work ﬁnancial resources, education of tomorrow’s medical is, therefore, substantially reduced compared to pre- doctors remains an important but difﬁcult task. While vious decades, and little is known on physician and participants of our survey rated education as very im- students’ opinions on this matter. We illustrate sur- portant despite its many challenges, the opinions to- vey results concerning on-job training, its difﬁculties, wards limited working hours were not as clear. Given and implications for restricted working hours. that over 50% are still undecided whether reduced Methods We conducted an internal survey among work hours may also positively inﬂuence medical ed- M.D. and Ph.D. students and medical staff members ucation, it clearly presents an opportunity to include at the Medical University of Vienna using the Med- the next generations of physicians in this undertaking. Campus system (CAMPUSOnline, Graz, Austria) and SPSS (V.21, IBM Corp, Armonk, NY, USA). Keywords Residency programs · Working hour restric- Results Participants were 36.5% staff members and tions · Survey on new working hours regulations · Aus- 63.5% students. Students rated continuous education trian survey · Arbeitszeitgesetz Österreich of physicians high at 9.19 ± 1.76 and staff members at 8.90 ± 2.48 on a 1–10 (1 unimportant, 10 most Introduction important) scale. Students rated limited time re- sources, while staff considered ﬁnancial resources as New regulations for working hours of medical doctors the greatest challenge for in-hospital education. Over- have been implemented in all 27 European member countries of the EU based on the European directive 2003/88/EG, effectively limiting physicians on-duty to The original version of this article was revised: The original 48 h per week. This regulation was accordingly imple- version of this article unfortunately contained a mistake. mented over the past years into Austrian law and has The presentation of the sentence “limiting on-duty working ever since reshaped the concept of on-duty hours in hours to 58h per week.” was incorrect. The correct Austrian hospitals, where traditionally 90 h were con- limitation of the on-duty working hours is 48h per week. sidered the norm . K. D. Bergmeister, M.D. Ph.D · M. Aman, M.D. Since the introduction of reduced working hours, CD Laboratory for the Restoration of Extremity Function, there has been a vital debate about the beneﬁts and Department of Surgery, Medical University of Vienna, disadvantages of this measure. Some consider this Vienna, Austria reduction in working hours a positive trend towards K. D. Bergmeister, M.D. Ph.D · M. Aman, M.D. · patient safety [2, 3] and employee-friendly working B. K. Podesser, M.D. () hours in line with modern concepts of work-life bal- Ludwig Boltzmann Cluster for Cardiovascular Research at ance . Based on several studies, reduced working the Center of Biomedical Research, Medical University of hours have been shown to prevent secondary mental Vienna, Spitalgasse 23, 1090 Vienna, Austria firstname.lastname@example.org diseases  and reduce the overall high suicide rate 404 Restricted working hours in Austrian residency programs K short report Fig. 1 a Challenges for in-hospital education as rated by stu- all 29% thought this is possible, whereas 19% did not. This dents and staff members. Students considered time resources number was higher in staff members (32%) than in students as the biggest challenge, whereas staff members considered (24%). A high number of participants did not know whether financial resources as the biggest challenge. b “Can restricted a positive or negative effect would result working hours positively influ ence medical education?”: Over- of medical doctors [6, 7]; however, others criticize the Methods negative effects on residency training, as some anal- yses on surgical training indicate that restricted op- We designed an in-house survey with several multiple erative exposure can negatively impact surgical per- choice questions to investigate the opinions on med- formance and thus patient outcomes [8, 9]. These ef- ical training and the current situation with respect to fects are thought to be further aggravated by the steep the new working hours. This survey was conducted learning curves of many novel surgical techniques, using the MedCampus system (CAMPUSOnline, Graz, limited teaching resources in times of high cost pres- Austria) of the Medical University of Vienna, and in- sure, more complex cases and generally sicker pa- cluded a total of 10,335 M.D. and Ph.D. students and tients . 3824 staff members. The survey preparations were Despite this vital ongoing debate about the pros conducted from January to October 2015, with the sur- and cons of reduced working hours on patient safety vey being accessible from October to December 2015. and teaching matters , there is little knowledge of The analysis took place from November 2015 to June doctors and students’ opinion on this matter. We be- 2017. Statistical analyses were conducted using Mi- lieve that this may, however, be a vital component in crosoft Excel and SPSS (V.21, IBM Corp, Armonk, NY, this discussion to positively shape the future of this USA). Prior to the survey, approval was obtained from profession in terms of well-educated doctors, patient the data privacy committee of the Medical University safety and work-life balance. In this study we present of Vienna. ﬁrst survey results of Austrian hospital staff members and students concerning on-job training, its difﬁcul- Results ties, and implications on restricted working hours. In our in-house survey, a total of 906 participants completed all relevant questions. This accounts for an 6.38% overall response rate of all students and staff members. The study’s participants were 36.5% staff K Restricted working hours in Austrian residency programs 405 short report members and 63.5% MD and PhD students. Overall, routine (Practical clinical year, “Klinisch Praktisches students rated continuous education of medical doc- Jahr”; [25, 26]). Some even consider extending resi- tors at 9.19 ± 1.76 and staff members at 8.90 ± 2.48 on dency programs with a current duration of (mostly) a 1–10 (1 unimportant, 10 most important) scale, in- 6 years to longer periods to compensate for the loss dicating its importance to the participants. of clinical exposure. Students (32%) considered limited available time, In this study, one limiting factor is the general re- while staff (34%) considered limited ﬁnancial re- sponse rate in our survey, which was, however, com- sourcesasthe greatest challenge for in-hospital parable to other medcampus surveys at our institu- education. Limited personnel, ﬁnancial and time tion. As indicated by the high number of undecided resources accounted for 80% in both groups. Less students and staff members, we believe it is necessary than 1% of either students or staff members believed to focus on the future of medical education now. It is there are no limitations for on-job training in Austrian unlikely that regulations regarding working hours will hospitals (Fig. 1a). change to traditional levels and thus medical doctors Overall, 28.85% thought that restricted working have to identify solutions for this challenge early be- hours can positively inﬂuence medical education, fore a dramatic loss in quality occurs. In our study, while 19.04% thought the opposite and 52.11% were ﬁnancial, staff as well as time resources were consid- undecided. The percentage of participants that were ered to be equally challenging for medical education. not sure if the new working hours could positively All need to be addressed to provide better education inﬂuence education, was higher in staff members either by an increase in budget for external resident (54%) compared to students (48%). Likewise, more training or for staff to compensate for training ab- staff members believed in a positive change (31%) sences. Obviously, these matters involve high costs for compared to students (24%) (Fig. 1b). hospital providers and demand a political motivation to invest in our healthcare system. Some federal states in Austria have already been forced to provide more Discussion staff and resources for training to compete with sur- Reduced working hours and the effects on the medical rounding countries for qualiﬁed staff members. The profession continue to be a highly discussed matter [3, political weight of such developments and the pos- 12–15]. Despite the vital debate between advocates sible decline of our healthcare system is signiﬁcant. and opponents of this change, our survey indicated Therefore, this agenda has emerged in recent electoral that the majority of affected students and staff mem- campaigns, both national and international, with in- bers are still uncertain if this trend is positive or neg- creasing frequency and attention. ative for medical education. Therefore, a large oppor- If we gather this momentum to shape medical ed- tunity is ahead to include affected doctors as well as ucation and the environment we work in, we may the next generation of doctors and mutually shape our very well be able to compensate for less time on professional environment accordingly. Clearly, a ma- duty without compromising the quality of our work. jor task in this undertaking is to ensure that the reduc- Furthermore, we can continue to ensure the trust of tion in clinical exposure does not negative inﬂuence our patients not only in our work but in the future the quality of our work. A number of publications of our medical system. This may however require have indicated that the current duration of residency a united approach to inform the public and politi- programs may not be able to provide the same level cians of the challenges ahead and their implications of education with reduced working hours [8, 9]. Al- on our healthcare system. though these results are not to be considered as ﬁnal [14, 15] they should, however, alert us to ﬁnd possi- Conclusion bilities to compensate for any possible loss in quality. This may involve the further outsourcing of admin- Considering the limited available time and ﬁnancial istrative tasks in order to focus the work of medical resources, education of tomorrow’s medical doctors doctors on treating patients. Other approaches test remains an important but difﬁcult task. While par- the use of artiﬁcial intelligence to help doctors in the ticipants of our survey likewise rated education as diagnosis and treatment of diseases or simply reduce very important despite its many challenges, the opin- tasks that do not require human interaction [16, 17]. ions towards limited working hours were not as clear. Furthermore, teaching has and will further evolve to Given that over 50% were still undecided whether transfer medical knowledge as well as procedures or reduced working hours can also positively inﬂuence surgeries in a faster pace to medical trainees. This medical education, it clearly presents an opportunity is achieved using modern media, training workshops to include the next generations of physicians in this and realistic computer or in vivo simulations [18–24]. undertaking. Also, medical schools have adapted to the need of Funding Open access funding provided by Medical Univer- training medical doctors ready for clinical work, by sity of Vienna. shifting from a theoretical learning approach to bed- side teaching and early involvement in the clinical 406 Restricted working hours in Austrian residency programs K short report Conﬂict of interest K.D. Bergmeister, M. Aman, and 12. Cerwenka H, Bacher H, Werkgartner G, Mischinger HJ. B.K. 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Wiener klinische Wochenschrift – Springer Journals
Published: Apr 27, 2018
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