Exploring the evolving concept of 'patient ownership' in the era of resident duty hour regulations-experience of residents and faculty in an internal medicine night float system.

BACKGROUND: Despite the use of 'patient ownership' as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations. METHODS: In this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership. RESULTS: We identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients' issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking. DISCUSSION: These features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.

Working Time Society consensus statements: Regulatory approaches to reduce risks associated with shift work-a global comparison.

A large number of workers worldwide engage in shift work that can have significant influences upon the quality of working life. For most jurisdictions, setting and enforcing appropriate policies, regulations, and rules around shift work is considered essential to (a) prevent potentially negative consequences of shift work and (b) to improve worker health and well-being. However, the best ways to do this are often highly contested theoretical spaces and often culturally and historically bound. In this paper, we examine the regulatory approaches to regulating shift work in four different regions: Europe, North America, Australasia, and East Asia (Japan, China, and Korea). Despite the fact that social and cultural factors vary considerably across the regions, comparing regulatory frameworks and initiatives in one region can be instructive. Different approaches can minimally provide a contrast to stimulate discussion about custom and practice and, potentially, help us to develop new and innovative models to improve worker well-being and organizational productivity simultaneously. In this paper, our goal is not to develop or even advocate a "perfect" sets of regulations. Rather, it is to compare and contrast the diversity and changing landscape of current regulatory practices and to help organizations and regulators understand the costs and benefits of different approaches. For example, in recent years, many western countries have seen a shift away from prescriptive regulation toward more risk-based approaches. Advocates and critics vary considerably in what drove these changes and the benefit-cost analyses associated with their introduction. By understanding the different ways in which shift work can be regulated, it may be possible to learn from others and to better promote healthier and safer environments for shift-working individuals and workplaces.

Working Time Society consensus statements: Prescriptive rule sets and risk management-based approaches for the management of fatigue-related risk in working time arrangements.

Traditionally, working time arrangements to limit fatigue-related risk have taken a prescriptive approach, which sets maximum shift durations in order to prevent excessive buildup of fatigue (and the associated increased risk) within shifts and sets minimum break durations to allow adequate time for rest and recovery within and/or between shifts. Prescriptive rule sets can be successful when, from a fatigue-related risk standpoint, they classify safe work hours as permitted and unsafe work hours as not permitted. However, prescriptive rule sets ignore important aspects of the biological factors (such as the interaction between circadian and homeostatic processes) that drive fatigue, which are critical modulators of the relationship between work hours and fatigue-related risk. As such, in around-the-clock operations when people must work outside of normal daytime hours, the relationship between regulatory compliance and safety tends to break down, and thus these rule sets become less effective. To address this issue, risk management-based approaches have been designed to regulate the procedures associated with managing fatigue-related risk. These risk management-based approaches are suitable for nighttime operations and a variety of other non-standard work schedules, and can be tailored to the particular job or industry. Although the purpose of these fatigue risk management approaches is to curb fatigue risk, fatigue risk cannot be measured directly. Thus, the goal is not on regulating fatigue risk per se, but rather to put in place procedures that serve to address fatigue before, during, and after potential fatigue-related incidents. Examples include predictive mathematical modeling of fatigue for work scheduling, proactive fatigue monitoring in the workplace, and reactive post-incident follow-up. With different risks and different needs across industries, there is no "one size fits all" approach to managing fatigue-related risk. However, hybrid strategies combining prescriptive rule sets and risk management-based approaches can create the flexibility necessary to reduce fatigue-related risk based on the specific needs of different work environments while maintaining appropriate regulatory oversight.

Historical Trajectory and Implications of Duty-Hours in Graduate Medical Education.

Duty-hours policies continue to be debated. Most know the pro and con arguments, but many may not be aware of background information preceding and intertwining the development and implementation of these policies. Interestingly, several aspects of law were involved or potentially correlated with policies enacted. This review updates new generations of physicians and scholars on the historical trajectory of duty-hour policies and highlights policy implications and the current state of evidence. In reviewing the historical and legal trajectory of duty-hours, many updates seemed to be a reaction to potential federal entanglement. Additionally, the review of the postimplementation literature revealed minimal empirical evidence. Instead, the majority of the positive findings were perception based. These summaries demonstrate a need for further outcomes evidence to validate policies.

Reformas al decreto 1441 del Congreso de la República, Código de Trabajo: decreto No. 007-2017 / Reforms to Decree 1441 of the Congress of the Republic, Labor Code: Decree No. 007-2017

Actualización del Código de trabajo -Decreto No. 1441- Reforma los artículos: 61 literal f); el 269; el 271; adiciona el 271 bis; reforma el 272; el 281; modifica la literal e) y adiciona la literal h) al artículo 292; reforma el artículo 415; crea el artículo 417 y el artículo 418. Contiene 13 Artículos.

Código de trabajo de Guatemala (edición rubricada y concordada con las normas internacionales del trabajo): decreto No. 1441 / Guatemalan Labor Code (edition signed and in accordance with international labor standards): Decree No. 1441

Este documento, que incluye el contenido íntegro y fiel del Código del Trabajo, está rubricada y concordada con las Normas Internacionales del Trabajo (NIT) ratificadas por Guatemala, las recomendaciones de la Organización Internacional del Trabajo (OIT) y las normas constitucionales que guardan relación con el Código. 431 Artículos.