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Table of Contents
SPECIAL REPORT
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 1-3

Student american veterinary medical association duty hours guidelines


1 College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
2 School of Veterinary Medicine, St. George's University, St. George's, Grenada
3 College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
4 Colorado State University College of Veterinary Medicine, Fort Collins, CO, USA
5 College of Veterinary Medicine, Auburn University, Auburn, AL, USA
6 Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
7 Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
8 American Veterinary Medical Association, Schaumburg, IL, USA

Date of Web Publication30-May-2019

Correspondence Address:
Ms. Stéphie-Anne C Duliepre
Cornell University College of Veterinary Medicine, 602 Tower Rd, Ithaca, NY 14853
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EHP.EHP_11_19

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  Abstract 


At the 2011 Student American Veterinary Medical Association (SAVMA) Symposium, the SAVMA House of Delegates officially endorsed its Duty Hours Guidelines. The purpose of the guidelines was to provide guidance to veterinary students at all SAVMA Chapters on appropriate duty hours during clinical rotations. A need to revisit the duty hour guidelines arose in 2018 as veterinary students throughout the United States expressed concerns with the applicability of some guidelines in their clinical years. To reflect the needs of all SAVMA Chapters, the guidelines were revised in light of current veterinary medical trends. Feedback was solicited from students and faculty at all 34 SAVMA Chapters with clinical programs via surveys and in person meetings. A total of 19 Chapters provided input that highlighted areas for improvement. Thus, SAVMA wishes to make clear the needs of veterinary students on their clinical rotations and provide revised duty hours guidelines. Although SAVMA does not have the regulatory authority to enforce compliance, the organization strongly encourages all AVMA-accredited institutions to both embrace and comply with the newly revised and recommended guidelines.

Keywords: Burnout, emotional exhaustion, ethics, medical education, mental health, sleep, veterinary medicine, wellness


How to cite this article:
Duliepre SAC, Seshadri A, Neuser SL, McFarland A, Gray MM, Malone E, Nafe L, Hall D. Student american veterinary medical association duty hours guidelines. Educ Health Prof 2019;2:1-3

How to cite this URL:
Duliepre SAC, Seshadri A, Neuser SL, McFarland A, Gray MM, Malone E, Nafe L, Hall D. Student american veterinary medical association duty hours guidelines. Educ Health Prof [serial online] 2019 [cited 2019 Jun 26];2:1-3. Available from: http://www.ehpjournal.com/text.asp?2019/2/1/1/259383




  Introduction Top


From its inception in 1969, formerly known as the National Conference of Student Chapters of the AVMA, the Student American Veterinary Medical Association (SAVMA) continues to work toward its single mission “to support, empower, and inspire all veterinary students in improving their lives, education and career, along with securing a better future for our profession through collaboration with our parent organization, the American Veterinary Medical Association (AVMA).” Veterinary students' well-being, at every stage of their veterinary training, and in all facets of their lives, is therefore at the heart of SAVMA's mission. For this reason, SAVMA finds it important to make a clear and unambiguous stance on the needs of veterinary students on their clinical rotations.

For over four decades, the correlation between the well-being of medical professionals and the quality of health-care organizations has been documented and understood in the health professions.[1],[2] Burnout, defined as the emotional exhaustion, cynicism, and reduction in efficiency that results from the constant exposure due to stressors faced on the job,[3] has tremendous negative impact on the personal lives of our medical professionals.[4] Despite the years of knowledge and data on burnout, 44% of US physicians continue to report experiencing it in some form.[5] In a direct correlation with the number of hours worked, the report shows that physicians who work 71 or more hours are 21% more likely to experience burnout than those who work 31–40 h a week.

The result of burnout in the medical profession can vary from difficulty in maintaining a healthy work–life balance and losing passion for one's work, to serious detriments to the health of the health-care provider themselves. Coronary heart disease, shorter life expectancy, problematic alcohol use, depression, and suicide are only some of the reported negative consequences associated with burnout known today.[6],[7] A 2018 study of 42,473 physicians concluded that physician burnout was directly linked to increase in poorer quality of care due to low professionalism, reduced patient satisfaction, and a two-fold increased odds for unsafe care, all statistics found in higher concentration among early career physicians.[8]

To address some of these clear dangers of burnout and depression, the Accreditation Council for Graduate Medical Education has outlined guidelines regarding well-being and fatigue mitigation, encouraging host institutions to implement changes such as to limit duty hours, in order to safeguard against the negative effects of chronic and acute sleep loss.[9],[10]

As early career individuals in similar teaching environments, veterinary students are not immune to these challenges. Given the parallels to human medicine and the specific challenges of veterinary medicine, immediate action is warranted. In the largest published study regarding the type and severity of medical errors in veterinary hospitals, the results indicate that as much as 15% of the errors (e.g., drug errors and poor communication) result in harm to a patient.[11] In addition to safe and proper patient care, well-being of our veterinary professionals is of equal concern. The Centers for Disease Control (CDC) reported in 2015 that 1 in 11 veterinarians had serious psychological distress and 1 in 6 experienced suicidal ideation since leaving veterinary school.[12]

Before completion of the DVM degree, veterinary students also face challenges that have led to the loss of students via suicide in recent years. Many confounding factors have been reported by students to affect their well-being in the clinic, such as the inability to consume a decent meal or properly take care of bodily functions, lack of appropriate rest periods between shifts, and the inability to follow through with mental health or other medical appointments due to fear of repercussions. To provide the best opportunity for veterinary students to thrive and successfully complete their veterinary education, SAVMA has provided a list of guidelines that aim to address the very issues veterinary student face on clinical rotations. These guidelines were developed with the knowledge that not all schools operate equally and are an attempt to balance the needs of a rigorous program with the well-being of students. In addition, though SAVMA does not have jurisdiction over interns and residents, the organization strongly supports these views for both entities.

It is important to note that by virtue of being guidelines, these statements are not requirements and therefore not enforceable by SAVMA. Nevertheless, they represent that the ideals and values of SAVMA and AVMA-accredited veterinary institutions are strongly encouraged to follow them. Students recognize that they are integral to the success and daily function of their teaching hospital, but SAVMA believes that their work must be balanced by appropriate levels of support staff and faculty to ensure student well-being and that the focus of their daily activities remain learning. SAVMA aims for these guidelines to serve as a reliable backbone in particular for veterinary students on clinical rotations, so they can be aware of the standards their national representation recommends with their health and well-being in mind.

The information provided within these guidelines was made possible due to feedback from veterinary students at the institutions listed in [Table 1].
Table 1: Veterinary institutions at which students, faculty, and staff participated in the survey to provide information and feedback for the development of the updated duty hours guidelines

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  Student American Veterinary Medical Association Duty Hours Guidelines Top


Regularly scheduled hours

  1. Adequate time for rest and personal activities should be provided. For all on-site (on-site refers to any work done within the veterinary facility or field in connection to the rotation and away from the student's home) daily duties and in-house calls over a 24 h period, a minimum consecutive 10 h break should be provided between shifts
  2. For every 6 consecutive hours of work, a break of minimum 30 min for meals should be provided. If an emergency situation interrupts this break, every attempt should be made that an alternate opportunity be provided to the student to consume a meal. Students should have the option to take two 30 min breaks after a 12 h shift for appropriate clinical rotations
  3. Students should be provided with 1 day in 7 free from all clinical responsibilities, averaged over the course of the length of the rotation. This should include on-site and on-call (on-call indicates the student is no longer on-site, but is available to work if being contacted by rotation leaders to report to on-site duty) duties, as well as mandatory in-class time
  4. Duty hours should be limited to 80 h/week, averaged over the course of the length of the rotation, inclusive of all on-call activities
  5. Students should be excused for medical, dental, and other health-related appointments, with allowance to make up hours.


On-call activities

  1. Continuous on-site duty, including on-call shifts, should not be scheduled to exceed 24 consecutive hours. Students may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. If continuous on-site and on-call clinical duties lasting for a consecutive 24 h period lack opportunity for rest and recovery, a 9 h rest period should be provided prior to the following shift
  2. No new patients may be accepted after 24 h of continuous duty
  3. On-call shifts should occur no more frequently than one shift in 3 days, averaged over the course of the length of the rotation.


Acknowledgement

We would like to give a special acknowledgment to the dedicated members of the 2018–2019 SAVMA Wellness Committee: Meggan M. Gray (chair), Sarah Scott, Bronwyn Turner, and Courtney Abbott. We would also like to thank the various members of the 2018–2019 SAVMA House of Delegates for their contributions in helping finalize our updated Duty Hours Guidelines at the 2019 SAVMA Symposium.

Financial support and sponsorship

The study was supported by the Student American Veterinary Medical Association and the American Veterinary Medical Association.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Firth-Cozens J. Interventions to improve physicians' well-being and patient care. Soc Sci Med 2001;52:215-22.  Back to cited text no. 1
    
2.
Firth-Cozens J, Greenhalgh J. Doctors' perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44:1017-22.  Back to cited text no. 2
    
3.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52:397-422.  Back to cited text no. 3
    
4.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-13.  Back to cited text no. 4
    
5.
Kane L. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. Available from: http://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#3. [Last retrieved on 2019 Jan 16].  Back to cited text no. 5
    
6.
Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg 2010;251:995-1000.  Back to cited text no. 6
    
7.
Shanafelt TD, Gradishar WJ, Kosty M, Satele D, Chew H, Horn L, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol 2014;32:678-86.  Back to cited text no. 7
    
8.
Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Intern Med 2018;178:1317-30.  Back to cited text no. 8
    
9.
Accreditation Council for Graduate Medical Education. The ACGME's Approach to Limit Resident Duty Hours 12 Months after Implementation: A Summary of Achievements; 2004. Available from: http://www.acgme.org/Portals/0/PFAssets/PublicationsPapers/dh_dutyhoursummary2003-04.pdf. [Last retrieved on 2019 Apr 30].  Back to cited text no. 9
    
10.
Accreditation Council for Graduate Medical Education. National Report of Findings 2018 Executive Summary; 2018. Available from: http://www.acgme.org/Portals/0/PDFs/CLER/CLER_2018_Executive_Summary_DIGITAL_081418.pdf. [Last retrieved on 2019 Apr 30].  Back to cited text no. 10
    
11.
Wallis J, Fletcher D, Bentley A, Ludders J. Medical errors cause harm in veterinary hospitals. Front Vet Sci 2019;6:12.  Back to cited text no. 11
    
12.
Nett RJ, Witte TK, Holzbauer SM, Elchos BL, Campagnolo ER, Musgrave KJ, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. J Am Vet Med Assoc 2015;247:945-55.  Back to cited text no. 12
    



 
 
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