The workday of hospital surgeons: what they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study.

BACKGROUND Many surgeons report passion for their work, but not all tasks are likely to be satisfying. Little is known about how hospital surgeons spend their days, how they like specific tasks, and the role of core tasks (i.e. surgery-related tasks) versus tasks that may keep them from core tasks (e.g., administrative work). This study aimed at a more detailed picture of hospital surgeons' daily work - how much time they spend with different tasks, how they like them, and associations with satisfaction. METHODS Hospital surgeons (N = 105) responded to a general survey, and 81 of these provided up to five daily questionnaires concerning daily activities and their attractiveness, as well as their job satisfaction. The data were analyzed using t-tests, analysis of variance, as well as analysis of covariance and repeated measures analysis of variance for comparing means across tasks. RESULTS Among 14 tasks, surgery-related tasks took 21.2%, patient-related tasks 21.7% of the surgeons' time; 10.4% entailed meetings and communicating about patients, and 18.6% documentation and administration. The remaining time was spent with teaching, research, leadership and management, and not task-related activities (e.g. walking between rooms). Surgery was rated as most (4.25; SD = .66), administration as least attractive (2.63; SD = .78). A higher percentage of administration predicted lower perceived legitimacy; perceived legitimacy of administrative work predicted job satisfaction (r = .47). Residents were least satisfied; there were few gender differences. CONCLUSIONS Surgeons seem to thrive on their core tasks, most notably surgery. By contrast, administrative duties are likely perceived as keeping them from their core medical tasks. Increasing the percentage of medical tasks proper, notably surgery, and reducing administrative duties may contribute to hospital surgeons' job satisfaction

Temporal factors in violence related injuries—An 11year trend analysis of violence-related injuries from a Swiss Emergency Department

Summary: Background: Injury from interpersonal violence is a major social and medical problem in the industrialized world. Little is known about the trends in prevalence and injury pattern or about the demographic characteristics of the patients involved. Methods: In this retrospective analysis, we screened the database of the Emergency Department of a large university hospital for all patients who were admitted for injuries due to interpersonal violence over an 11year period. For all patients identified, we gathered data on age, country of origin, quality of injury, and hospitalization or outpatient management. A trend analysis was performed using Kendall's tau-b correlation coefficients for regression analysis. Results: The overall number of patients admitted to our Emergency Department remained stable over the study period. Non-Swiss nationals were overrepresented in comparison to the demographics of the region where the study was conducted. There was a trend toward a more severe pattern of injury, such as an increase in the number of severe head injuries. Conclusions: Although the overall number of patients remained stable over the study period, there was an alarming trend toward a more severe pattern of injury, expressed by an increase in severe head trauma

Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments.

Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots.An electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd.In all, 279/497 (56%) of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (p<0.001). The latter agreed more with work-hour limitations in general than in medicine (p<0.001). The most often cited arguments in favour of work-hour limitations were "quality and patient safety," "health and fitness," and "leisure and work-family balance," whereas the lack of "flexibility" was the most important argument against. Surgeons expected more often that their "education" and the "quality of their work" would be threatened (p<0.001).Work-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value

Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland

<p>Abstract</p> <p>In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.</p

On-table reconstruction of comminuted fractures of the radial head

The most widely accepted treatment for comminuted fractures of the radial head is either the excision or open reduction and internal fixation. The purpose of the present study is to evaluate the value of an 'on-table' reconstruction technique in severely comminuted fractures of the radial head. In this study, two patients with a Mason type-III and four patients with a Mason type-IV radial-head fracture were treated with 'on-table' reconstruction and fixation using low-profile mini-plates. After a mean follow-up of 112 months (47-154 months), the mean elbow motion was 0-6-141 degrees extension flexion with 79 degrees of pronation and 70 degrees of supination. The mean Broberg and Morrey functional rating score was 97.0 points, the Mayo Elbow Performance Index was 99.2 points and the mean Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure score was 1.94 points. One patient had symptoms of degenerative changes, with a slight joint-space narrowing. There were no radiographic signs of devitalisation at final examination. Comminuted fractures of the radial head, which would otherwise require excision, can be successfully treated with an 'on-table' reconstruction technique

Mentoring in general surgery in Switzerland

Background: Mentorship has been found as a key factor for a successful and satisfying career in academic medicine and surgery. The present study was conducted to describe the current situation of mentoring in the surgical community in Switzerland and to evaluate sex differences regarding the impact of mentoring on career success and professional satisfaction. Methods: The study was designed as an anonymous national survey to all members of the Swiss Surgical Society in 2011 (820 ordinary and 49 junior members). It was a 25-item questionnaire addressing mentor–mentee relationships and their impact on the professional front. Results: Of the 869 mailed surveys, 512 responses were received (response rate: 58.9%). Mentor–mentee relationships were reported by 344 respondents (68.1%) and structured mentoring programs were noted in 23 respondents (6.7%). Compared to individuals without mentors, male mentees exhibited significantly higher subjective career advancement (5.4±1.2 vs. 5.0±1.3; p=0.03) and career development (3.3±1.9 vs. 2.5±1.7; p<0.01) scores, but the differences for female mentees were not statistically significant (4.7±1.1 vs. 4.3±1.2, p=0.16; 2.5±1.6 vs. 1.9±1.4, p=0.26; respectively). The pursuit of an academic career was not influenced by the presence of a mentor–mentee relationship for female (p=0.14) or male participants (p=0.22). Conclusions: Mentor–mentee relationships are important for the career advancement of male surgeons. The reason for the lack of an impact on the careers of female surgeons is difficult to ascertain. However, mentoring also provides lifelong learning and personal development. Thus, specific attention should be paid to the development of more structured mentoring programs for both sexes

Number of arguments for (n = 714) work-hour limitations given by 224 male and 48 female surgeons, lawyers, and pilots (overall 7 missing values).

<p>Number of arguments for (n = 714) work-hour limitations given by 224 male and 48 female surgeons, lawyers, and pilots (overall 7 missing values).</p

Number of arguments against (n = 362) work-hour limitations given by 64 surgeons, 65 lawyers, and 92 pilots (overall 58 missing values).

<p>Number of arguments against (n = 362) work-hour limitations given by 64 surgeons, 65 lawyers, and 92 pilots (overall 58 missing values).</p

Number of arguments against (n = 362) work-hour limitations given by 181 male and 38 female surgeons, lawyers and pilots (overall 60 missing values).

<p>Number of arguments against (n = 362) work-hour limitations given by 181 male and 38 female surgeons, lawyers and pilots (overall 60 missing values).</p