Challenges, duty hours, and metrics in the intensive care unit resident rotation.

摘要

Most practicing intensivists experienced very different intensive care unit (ICU) rotations during their training than the current generation of residents and fellows. Constant evolution of critical care science, duty hour restrictions, and good evidence that extended work hours contribute to ICU errors (1) are the major factors that have driven changes in the structure of resident ICU training. Although a few exceptions exist (see Ref. 2), many ICUrotation changes have not been accompanied by rigorous and well-designed studies to examine the intended and unintended impact of these changes on critical care education.One source of uncertainty in the design of residency rotations is the amount of time that general residents should spend in the ICU. There may be no definitive answer to the question of "what is the ideal number of duty hours or months spent in the ICU?" However, in this issue of Critical Care Medicine, Mul-lon et al (3) have made an important attempt to improve our understanding of "The impact of adding one month of ICU training in a Categorical Internal Medicine Residency Program." Unexpectedly, the main results of their analysis were "no significant or sustained benefit in the observed cognitive or clinical skills of the residents who received one additional month of ICUtraining." Although disappointing, these results are of great significance within the larger context of ICU resident education. These results should provoke a broad discussion on the design and implementation of resident training curricula in the ICU.