Changes in the working conditions and learning environment of medical residents after the enactment of the Medical Resident Act in Korea in 2015: a national 4-year longitudinal study

The effects of resident work hours on well-being, performance, and education: A review from a Japanese perspective

This article examines the impact of working-hour restrictions on the well-being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80-hour-per-week regulation in the United States and the 48-h-per-week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working-hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working-hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.

Developing prompts from large language model for extracting clinical information from pathology and ultrasound reports in breast cancer

PURPOSE

We aimed to evaluate the time and cost of developing prompts using large language model (LLM), tailored to extract clinical factors in breast cancer patients and their accuracy.

MATERIALS AND METHODS

We collected data from reports of surgical pathology and ultrasound from breast cancer patients who underwent radiotherapy from 2020 to 2022. We extracted the information using the Generative Pre-trained Transformer (GPT) for Sheets and Docs extension plugin and termed this the "LLM" method. The time and cost of developing the prompts with LLM methods were assessed and compared with those spent on collecting information with "full manual" and "LLM-assisted manual" methods. To assess accuracy, 340 patients were randomly selected, and the extracted information by LLM method were compared with those collected by "full manual" method.

RESULTS

Data from 2,931 patients were collected. We developed 12 prompts for Extract function and 12 for Format function to extract and standardize the information. The overall accuracy was 87.7%. For lymphovascular invasion, it was 98.2%. Developing and processing the prompts took 3.5 hours and 15 minutes, respectively. Utilizing the ChatGPT application programming interface cost US $65.8 and when factoring in the estimated wage, the total cost was US $95.4. In an estimated comparison, "LLM-assisted manual" and "LLM" methods were time- and cost-efficient compared to the "full manual" method.

CONCLUSION

Developing and facilitating prompts for LLM to derive clinical factors was efficient to extract crucial information from huge medical records. This study demonstrated the potential of the application of natural language processing using LLM model in breast cancer patients. Prompts from the current study can be re-used for other research to collect clinical information.

Developing and Establishing a Wound Dressing Team: Experience and Recommendations

BACKGROUND

The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of wound-dressing teams for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound-dressing team by reporting our experiences with the establishment of a wound-dressing team.

METHODS

The wound-dressing team was established at Korea University Guro Hospital. Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wound-dressing team. The data were analyzed to assess the types of wounds and their outcomes. In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members.

RESULTS

Regarding the wound type, 80,297 (45.3%) were catheter-related, while 48,036 (27.1%), 26,056 (14.7%), and 20,739 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores of the patient, ward nurse, dressing team nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively. Additionally, 136 dressing-related complications (0.08%) were reported.

CONCLUSION

The wound dressing team can enhance satisfaction among patients and healthcare providers with low complications. Our findings may provide a potential framework for establishing similar service models.

The Number of Monthly Night Shift Days and Depression Were Associated with an Increased Risk of Excessive Daytime Sleepiness in Emergency Physicians in South Korea

This study aimed to report the prevalence and identify the factors associated with excessive daytime sleepiness (EDS) among emergency physicians in South Korea. We analyzed the Korean Emergency Physicians Survey data from 15 January to 26 February 2021. EDS was evaluated using the Epworth sleepiness scale, and a score of 11 or more indicated the presence of EDS. We conducted univariable and multivariable logistic regression analyses to verify the associated factors. A total of 1307 participants responded to the survey, and the response rate was 61.3%. Nine hundred fifty-four participants were included in the study. Two hundred ninety-three participants were classified as the EDS group, and six hundred sixty-one were classified as the non-EDS group. The prevalence of EDS was 30.7% (95% confidence interval (CI), 27.8–33.6%). Monthly night-shift days (odds ratio (OR) 1.106, 95% CI 1.028–1.191) and depression (OR 2.635, 95% CI 1.799–3.861) were significantly associated with an increased risk of EDS, and fair sleep quality (OR 0.560, 95% CI 0.318–0.985) was associated with a decreased risk of EDS. Almost one in three emergency physicians in South Korea suffer from daytime sleepiness. The number of monthly night-shift days and depression were associated with an increased risk of EDS.

Shortening shift’s length—Should we ask the residents if this is what they want?

Introduction

Work overload in hospitals enforced reducing shifts length of physicians in many countries over the last decade. In Israel, the current shift standard is of 26 hours, however, there is a residents’ struggle alongside a governmental intent to short the shifts to 16 hour. We aim to evaluate residents and interns support and preferences regarding shortening shifts and their ramifications to quality of life and residency programs.

Methods

A structured questionnaire was distributed to all resident and interns in a single center. We evaluated their current quality of residency and life, their support in the shorter shifts model, offering alternative program components such as reduced pay, longer residency or replacement in order to allow rest. We compared those who support the new model to those who objected to identify common characteristics to draw a resident profile for acceptance of change.

Results

Overall, 151 physicians answer the questionnaire. 70.2% support the shorter shifts model. Residents above 35 years old and those reaching completion of residency, significantly less support the shortening shifts model. No other demographic nor professional parameters were different between the supporters and non-supporters. Option of reduced pay or longer residency dramatically reduced the support rate to less than 30% and 20%, respectively. Replacement by other physician (resident or senior physician) in order to allow rest was supported by only 40%.

Conclusion

Residents’ standpoints regarding a desirable change are crucial to plan a successful implementation. A national survey is required before a new model is introduced, to achieve an optimal transparent efficient process.