Professionalism in the twilight zone: A multicenter, mixed-methods study of shift transition dynamics in surgical residencies

James E. Coverdill, Adnan Alseidi, David C. Borgstrom, Daniel L. Dent, Russell D. Dumire, Jonathan Fryer, Thomas H. Hartranft, Steven B Holsten, M. Timothy Nelson, Mohsen Shabahang, Stanley Sherman, Paula M. Termuhlen, Randy J. Woods, John D. Mellinger

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 oncall resident or night team because of sparse night staffng, patient ownership, an aversion to dumping, and the fear of being seen as ineffcient. 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.

Original languageEnglish (US)
Pages (from-to)S31-S36
JournalAcademic Medicine
Volume91
Issue number11
DOIs
StatePublished - Nov 1 2016

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Internship and Residency
resident
Interviews
shift work
surgery
Ownership
interview
Fear
professionalism
Professionalism
mentality
quotation
minority
anxiety
reform
questionnaire

ASJC Scopus subject areas

  • Education

Cite this

Coverdill, J. E., Alseidi, A., Borgstrom, D. C., Dent, D. L., Dumire, R. D., Fryer, J., ... Mellinger, J. D. (2016). Professionalism in the twilight zone: A multicenter, mixed-methods study of shift transition dynamics in surgical residencies. Academic Medicine, 91(11), S31-S36. https://doi.org/10.1097/ACM.0000000000001358

Professionalism in the twilight zone : A multicenter, mixed-methods study of shift transition dynamics in surgical residencies. / Coverdill, James E.; Alseidi, Adnan; Borgstrom, David C.; Dent, Daniel L.; Dumire, Russell D.; Fryer, Jonathan; Hartranft, Thomas H.; Holsten, Steven B; Timothy Nelson, M.; Shabahang, Mohsen; Sherman, Stanley; Termuhlen, Paula M.; Woods, Randy J.; Mellinger, John D.

In: Academic Medicine, Vol. 91, No. 11, 01.11.2016, p. S31-S36.

Research output: Contribution to journalArticle

Coverdill, JE, Alseidi, A, Borgstrom, DC, Dent, DL, Dumire, RD, Fryer, J, Hartranft, TH, Holsten, SB, Timothy Nelson, M, Shabahang, M, Sherman, S, Termuhlen, PM, Woods, RJ & Mellinger, JD 2016, 'Professionalism in the twilight zone: A multicenter, mixed-methods study of shift transition dynamics in surgical residencies', Academic Medicine, vol. 91, no. 11, pp. S31-S36. https://doi.org/10.1097/ACM.0000000000001358
Coverdill, James E. ; Alseidi, Adnan ; Borgstrom, David C. ; Dent, Daniel L. ; Dumire, Russell D. ; Fryer, Jonathan ; Hartranft, Thomas H. ; Holsten, Steven B ; Timothy Nelson, M. ; Shabahang, Mohsen ; Sherman, Stanley ; Termuhlen, Paula M. ; Woods, Randy J. ; Mellinger, John D. / Professionalism in the twilight zone : A multicenter, mixed-methods study of shift transition dynamics in surgical residencies. In: Academic Medicine. 2016 ; Vol. 91, No. 11. pp. S31-S36.
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