Report of the ACGME Work Group on Resident Duty Hours. June 11, 2002: 1-8.

Provides recommendations for creating an appropriate learning experience for residents. Emphasis is placed upon the responsibilities of programs, sponsoring institutions, and the accrediting body related to patient safety.

Beebe, S. Nurses' Perception of Beeper Calls: Implications for Resident Stress and Patient Care. Arch Pediatr Adolesc Med. 1995;149:187-191.

Describe beeper calls made by nurses to physicians and compares the nurses' ratings of the urgency of the beeper calls with the physicians' responses to the calls. Physicians respond to beeps fast but over half are 'routine' beeps.

Daugherty S., Baldwin D., Rowley B. Learning, Satisfaction, and Mistreatment During Medical Internship: A National Survey of Working Conditions. JAMA. 1998; 279(15):1194-1199.

Concerns about the working and learning environment of residency training continue to surface. Previous surveys of residents have focused on work hours and income, but have shed little light on how residents view their training experience. Results showed only a moderate level of satisfaction with their first year of residency. Satisfaction with residency experience was associated with the presence of factors that enhanced learning, and fewer experiences of perceived mistreatment.

Dean B., Schachter M., Vincent C., Barber N. Causing of prescribing errors in hospital inpatients: a prospective study. Lancet. 2002;359:1373-1378.

To prevent errors made during provider prescription of drugs, we need to know why they arise. Mistakes are made because of slips in attention, or did not apply relevant rules. Hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation.

Defoe D., Power M., Holzman G., Carpentieri A., Schulkin J. Long Hours and Little Sleep: Work Schedules of Residents in Obstetrics and Gynecology. Obstetrics & Gynecology. 2001;97(6):1015-1018.

Investigating resident work schedules and their attitudes toward their hours. Residents report working long hours, and wanting to limit their hours to reduce fatigue.

Gaba D. Physician Work Hours: The "Sore Thumb" of Organizational Safety in Tertiary Health Care. Enhancing Patient Safety and Reducing Errors in Health Care. 1998;Nov8-10: 302-305.

Comparison of safety and work practices in heath care to other high-hazard industries. Explanation of work hour limitations and regulation in the amount of hours worked in health care, and the impact that fatigue plays upon physicians.

Kim S., Giardino A., Casey R., Magnusson M., Pinto-Martin J. Experiences and Reflections of Former Pediatric Chief Residents. Arch Pediatr Adolesc Med. 1994;148: 518-521.

Comparison the actual and ideal time commitments of pediatric chief residents between 1972 and 1992 and to determine if actual time commitments have changed.

Krueger G. Fatigue, Performance, and Medical Error. In: Bogner, MS ed. 'Human Error in Medicine.' Hillsdale.: Lawrence Erlbaun Assoc., 1994:311-326.

Focuses upon shiftwork, disruptions of bodily circadian rhythms, sleep loss, fatigue, and performance expectations of health care providers as they pertain to sustained vigilant monitoring of patients, the likelihood of fatigue-related error, and other safety aspects of providing institutional health-care services.

Laine C., Goldman L., Soukup J., Hayes J. The Impact of a Regulation Restricting Medical House Staff Working Hours on the Quality of Patient Care. JAMA. 1993;269(3):374-378.

Examines the impact on patient care of a New York State regulation that restricted house staff working hours. Limiting the hours did not necessarily decrease serious outcomes.

Linigard L., Reznick R., Espin S., Regehr G., DeVito I. Team Communications in the Operating Room: Talk Patterns, Sites of Tension, and Implications for Novices. Academic Medicine. 2002;77(3):232-236.

The importance of communication in practice, specifically in the OR. Identified were patterns, sites of tension, and impact on novices. Recurrent themes of tension existed between operating room team members from surgery, nursing, and anesthesia and the negative effects tension has had on novices in the OR.

Malone M., Steele D., Jackson T. What Do Senior Internal Medicine Residents Do Their Continuity Clinics? J Gen Intern Med. 1993;8:185-188.

Investigates the activities of second and third-year internal medicine residents during their outpatient continuity clinics. What was examined was how year of training, number of patients seen, and resident nonclinical rotations at the time of the study influenced the allocation of time in the clinic setting.

Melgar T., Schubiner H., Burack R., Aranha A., Musial J. A Time-Motion Study of the Activities of Attending Physicians in an Internal Medicine and Internal Medicine-Pediatrics Resident Continuity Clinic. Academic Medicine. 2000;75:1138-1143.

Describes the activites of attending physicians in a residency-based continuity clinic to examine factors that affect their teaching of, supervision of, and interaction with residents. Attending physicians' actvities varied between direct contact with residents which utilized 43.1% of their time, clinic operations, 33.7% of their time, personal/professional activities , 18%, and miscellaneous activites 5.2%.

Meyer G., Massagli M. The Forgotten Component of the Quality Triad: Can We Still Learn Something from "Structure"? Journal on Quality Improvement. 2001; 27(9): 484-493.

The importance of structural measures to the assessment of quality. Measuring aspects of the physical environment, working conditions, organizational culture, and provider satisfaction, can be helpful to establish links to process and outcome measures.

Nerenz D., Rosman H., Newcomb C., Bolton M., Heudebert G., Simmer T., Goldstein S. The On-Call Experience of Interns in Internal Medicine. Arch Intern Med. 1990;150: 2294-2297.

Examines the structure and content of residency program in Internal Medicine, by assessing the interns' activities on call to identify problems with the workload scheduling, supervision, or learning.

Weinger M., Vara S., Herndon C., Howard S., Smith B., Mazzei W., Rosekind M., Gaba D. Evaluation of the Effects of Fatigue and Sleppiness on Clinical Performance in On-call Anesthesia Residents During Actual Nightime Cases and in Simulated Cases. Enhancing Patient Safety and Reducing Errors in Health Care. 1998; Nov 8-10: 306-310.

Anesthesia residents were studied to examine the effects of fatigue and sleep deprivation upon their skills to assure patient safety. They were studied at two different times to compare the amount of fatigue during day hours and night hours. Workload was higher among those at night in comparison with those during the day.

Yedidia M., Lipkin M., Schwartz M., Hirschkorn C. Doctors as Workers: Work-hour Regulations and Interns' Perceptions of Responsibility, Quality of Care, and Training. J Gen Intern Med. 1993;8:429-435.

Study of residents' perceptions of their responsibility for patients, the quality of patient care, and their learning experiences in light of new work-hour regulations.