1. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PHILIPPINE COLLEGE OF SURGEONS (PCS) and PHILIPPINE ASSOCIATION OF TRAINING OFFICERS IN SURGERY (PATOS) PHILIPPINE COLLEGE OF SURGEONS 62ND ANNUAL CLINICAL CONGRESS Kamia Rm. EDSA Shangrila Hotel Mandaluyong City December 3 (Sunday), 2006

2. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE SLEEP IS A STRANGER TO MANY MANAGERS. RESEARCH BY LEADING SCIENTISTS SHOWS JUST HOW DANGEROUS THAT PROBLEM IS PROF. CHARLES A. SZEISLER, BALDINO PROFESSOR OF SLEEP MEDICINE SLEEP DEFICIT: THE PERFORMANCE KILLER HARVARD MEDICAL SCHOOL OCTOBER 2006

3. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE STAY AWAKE LONGER THAN 18 CONSECUTIVE HOURS, AND YOUR REACTION SPEED, SHORT-TERM & LONG-TERM MEMORY, ABILITY TO FOCUS, DECISION-MAKING CAPACITY, MATH PROCESSING, COGNITIVE SPEED, AND SPATIAL ORIENTATION ALL START TO SUFFER DITTO

4. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE....FRENZIED CULTURES STILL CONFUSE SLEEPLESSNESS WITH VITALITY AND HIGH PERFORMANCE... DITTO

5. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE....THIS IS REASON PERHAPS THAT AMONG AMBITIOUS MANAGERS, DOCTORS, TRADERS, LAWYERS, AND LEADERS, AFTER OIL, THE SECOND MOST-WIDELY SOLD COMMODITY IS... COFFEE.....

6. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE.... SLEEPLESS MACHISMO.... IS THE ANTITHESIS OF INTELLIGENT MANAGEMENT... DITTO

7. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE INSTITUTIONAL PREVENTION OF ENDANGERMENT: NO TO: SMOKING DRINKING DRUGS SEXUAL HARASSMENT JUST BE ON PRETTY MUCH AROUND THE CLOCK - SELF- DESTRUCTION

8. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE IF THEY AVERAGE 4 HOURS OF SLEEP A NIGHT FOR 4-5 DAYS, THEY DEVELOP THE SAME LEVEL OF COGNITIVE IMPAIRMENT AS IF THEYD BEEN AWAKE FOR 24 HOURS - EQUIVALENT TO LEGAL DRUNKENNESS CZEISLER, C

9. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE SLEEPLESSNESS OR LACK OF IT: HEALTH HAZARD OCCUPATIONAL HAZARD

10. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE BURNOUT SYNDROME (BOS) STRESS DISORDERS EMOTIONAL EXHAUSTION DEPERSONALIZATION LACK OF PERSONAL ACCOMPLISHMENT FEELING OF ILL-HEALTH

11. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE RELATIVE INCIDENCES OF BOS SAUDI ARABIA (AUG 05) - 44-60% ORTHO/TRAUMA SURGEONS, KING FADH UNIVERSITY HOSPITAL SPAIN (APR 02) - 40-82% - PEDIA SURGEONS, HOSPITAL UNIVERSITARIO, GRANDA USA (OCT 01) - 4-32% - AMERICAN SURGEONS, ANN ARBOR, MICHIGAN

12. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON TRAINING & PATIENT CARE....PEOPLE WHO FAIL TO RELAX..... ARE THE PEOPLE WHO DIE EARLY.... LES WAAS, FOUNDER, PROCRASTINATORS CLUB OF AMERICA

13. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE AIM: TO DETERMINE THE PROBABLE IMPACT OF REDUCED RESIDENTS WORK HOURS ON SURGICAL TRAINING AND PATIENT CARE IN ACCREDITED PROGRAMS AS PERCEIVED BY THEIR CHAIRPERSONS, TRAINING OFFICERS AND CHIEF RESIDENTS.

14. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE OBJECTIVES DEFINE SURGICAL TRAINING & PATIENT CARE SHOW PROFILE OF RESPONDERS SHOW WORK HOUR PROFILE OF ACCREDITED TRAINING PROGRAMS SHOW PERCEIVED IMPACT ON SURGICAL TRAINING DEMONSTRATE PERCEIVED IMPACT ON PATIENT CARE

15. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE METHODOLOGY NON-VALIDATED SURVEY INSTRUMENT CHAIRMAN TRAINING OFFICER CHIEF RESIDENT ACCREDITED TRAINING PROGRAMS IN GENERAL SURGERY SEPTEMBER - NOVEMBER, 2006

16. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE METHODOLOGY NON-VALIDATED SURVEY INSTRUMENT CHECK-LIST FORMAT 4 PARTS: 18 QUESTIONS: PROFILE, CURRENT WORK HOUR, PERCEIVED IMPACT ON SURGICAL TRAINING & PERCEIVED IMPACT ON PATIENT CARE TARGET RESPONDENTS: CHAIRMAN, TRAINING OFFICER, CHIEF RESIDENT PERCEPTIONS OF RESPONDERS ARE NOT STRATIFIED NO FREE-FORM COMMENTS

17. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE OUTCOME MEASURES AVERAGE IN-HOSPITAL WORK HOURS PER WEEK FREQUENCY OF 24-HOUR DUTY T.O.-TRAINEE CONTACT TIME (MENTORSHIP) NUMBER & VARIETY OF CASES PATIENT CARE TIME (ROUNDS, OPERATING, ASSISTING) CONFERENCES & TEACHING ROUNDS RESIDENTS QUALITY OF LIFE STRESS, FAMILY & FEELING OF SATISFACTION ERRORS OF JUDGMENT & TECHNICAL MISTAKES

18. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE LIMITATIONS NON-VALIDATED SURVEY INSTRUMENT DELIMITED TO GS PROGRAMS ONLY EXCLUDED JUNIOR & MEDIUM LEVEL TRAINEES OUTCOME ARE PERCEPTIONS (NOT OBJECTIVE PARAMETERS) NO CORRELATION TO OUTCOME ANALYSES NO CORRELATION TO PBS-RITE OUTCOME STRUCTURED RESPONSES (NOT AT-LIBERTY) ONE-TIME SURVEY (NOT AN ACTUAL LOG)

19. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE DEFINITION REDUCED RESIDENTS WORK HOURS - FROM CURRENT TO 80-HOUR WORK WEEK INCLUDING DUTY HOURS PERCEIVED IMPACT - ANTICIPATED OR FORECASTED POSITIVE AND/OR NEGATIVE EFFECTS SURGICAL TRAINING - CURRICULUM, TRAINEE, TRAINER, NUMBER & VARIETY OF CASES PATIENT CARE - QUALITY & CONTINUITY

20. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PCS ACCREDITED TRAINING PROGRAMS PSGS - 64 PAO - 42 AFN - 7 PSPS - 3 PSO-HNS - 25 PSCRS - 2 PUA - 11 POA - 18 PATACSI - 8 PPRAS - 10

21. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE RESPONDERS 123 RESPONDERS 49 / 64 ACCREDITED GS PROGRAMS 76.5%

22. REDUCED RESIDENTS WORK HOUR: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS 60 GOVT. INSTITUTIONS 51 PRIVATE INSTITUTIONS 25 UNIVERSITY-BASED HOSPITALS 39 NON-UNIVERSITY-BASED HOSPITALS

23. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS SIZE OF INSTITUTION < 100 BEDS 9 7.9% 101-300 54 47.8 301-400 17 15.0 401-600 21 18.6 >600 12 10.6

24. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS POSITION CHAIRMAN 40 32.5% TRAINING OFFICER 46 37.4 CHIEF RESIDENT 36 29.2

25. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS GENDER MALE 113 91.8% FEMALE 7 5.7

26. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS YEARS IN POSITION < 3 YRS 70 56.9% 3-5 32 26.0 > 5 21 17.0

27. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF RESPONDERS LENGTH OF GS TRAINING PROGRAM 4 YRS 36 29.3% 5 84 68.3

28. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE IN-HOSPITAL WORK HOURS PROFILE FREQUENCY OF 24-HOUR DUTY Q OTHERQ 2 DAYSQ 3 DAYSON CALL JUNIOR2624675 MIDDLE1922705 SENIOR1927603 CHIEF24175222

29. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF IN-HOSPITAL WORK HOURS ESTIMATED IN-HOSPITAL STAY PER WEEK: HOURS 406080120>120 JUNIOR1836715 MIDDLE1836723 SENIOR1539676 CHIEF14305129

30. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF IN-HOSPITAL WORK HOURS ESTIMATE DEDICATED HRS/WEEK FOR PATIENT CARE HOURS30405060>60 JUNIOR62718633 MIDDLE62521613 SENIOR62619583 CHIEF61426663

31. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF IN-HOSPITAL WORK HOURS ESTIMATE HRS/WK FOR NON PATIENT CARE TASKS (RESEARCH & CONFERENCES) HOURS1015202530 JUNIOR324227215 MIDDLE323929314 SENIOR304027512 CHIEF2834351112

32. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PROFILE OF IN-HOSPITAL WORK HOURS ESTIMATE HRS/WK MENTORING TIME HOURS2030405060 JUNIOR7122 18 36 MIDDLE70231636 SENIOR53371256 CHIEF44362397

33. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPANT ON SURGICAL TRAINING & PATIENT CARE PERCEIVED IDEAL IN-HOSPITAL WORK HOURS PER WEEK HOURS406080120>120 JUNIOR71672180 MIDDLE71672180 SENIOR71667171 CHIEF41163256

34. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PERCEIVED IDEAL FREQUENCY OF 24-HOUR DUTY FREQ/WKONCETWICETHRICEON CALL JUNIOR056598 MIDDLE056598 SENIOR046669 CHIEF0405922

35. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PERCEIVED EFFECT ON SURGICAL CURRICULUM NO EFFECT5940.4% REQUIRES CURRICULAR CHANGES 5135.0 PROLONGATION OF TRAINING PROGRAM 3624.7

36. REDUCED RESIDENTS WORK HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PERCEIVED EFFECT ON TRAINEES QUALITYPOORERBETTERCANT PREDICT SKILLS48720 KNOWLEDGE18955 ATTITUDE29881

37. REDUCED RESIDENTS WORK JOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE PERCEIVED EFFECT ON MENTORING MORE EFFECTIVE CONTACT TIME 82 LESS EFFECTIVE CONTACT TIME 26 MORE RELIABLE EVALUATION OF PERFORMANCE 82 LESS RELIABLE EVALUATION OF PERFORMANCE 32

38. REDUCED RESIDENTS WORL HOURS: PERCEIVED IMPACT ON SURGICAL TRAINING & PATIENT CARE SUMMARY MEAN IN-HOSPITAL STAY 120 HRS/WK FREQUENCY OF 24-HR DUTY IS 3 TIMES PER WEEK PROPENSITY TOWARD PERCEIVED POSITIVE IMPACT OF REDUCED RESIDENTS WORK HOURS ON TRAINING & PATIENT CARE

39. ...THE OBSESSIVE-COMPULSIVE PERSONALITIES ARE MOST PRONE TO BURNOUT SYNDROME... FRANK MINIRTH, MD & CHRIS THRUMAN, PHD, BEFORE BURNOUT BALANCE LIVING FOR BUSY PEOPLE, 1990

40. NEVER DO TODAY WHAT YOU CAN PUT OFF TILL TOMORROW PAUL MEIER, MD, ADVISE TO ALL OBSESSIVE COMPULSIVES

41. THANK YOU