In keeping with the themes identified, PAIRO developed some specific initiatives in order to optimize working condi-tions. The initiatives reflect the complex and interrelated na-ture of work hours, working conditions and training and also address global factors such as resident respect, professional behaviour, and motivation.

The following flow diagram illustrates how the group’s thinking evolved as specific themes relating to work hours were discussed.

ResultsThe overall result of the group sessions was a clarifica-

tion of the vision of the organization and its responsibilities to its members.

OPTIMIZING RESIDENT WORKING CONDITIONS

BackgroundResident associations began to emerge in Canada in the

early 1960’s with campaigns for improved working condi-tions including appropriate work hours for residents. As as-sociations pressed for limits to the maximum number of hours a resident could work, they galvanized much support amongst trainees. Since health care is funded provincially, agreements are negotiated by each provincial resident orga-nization and thus work hour restrictions vary across Canada.

Currently in Ontario, there are limitations on the number of in house overnight call (eg. 1 in 4 in hospital call), as well as a maximum number of weekends per month that a resident can work. Maximum consecutive work hours also exist for those residents working shifts. In the last round of negotiations it was also agreed that residents would be relieved of their duties fol-lowing the handover of clinical responsibilities after a 24hr period of providing patient care.

The Professional Association of Internes and Residents (PAIRO) is the resident-run organization that represents over 4600 residents in Ontario. Formed and supported by members, PAIRO employs a full time staff to help develop and implement the goals of its members. PAIRO exists to champion the issues that help residents to be their best to ensure optimal patient care.

PAIRO interacts directly with a broad spectrum of stake-holders who directly and indirect influence and shape the working conditions of its resident members.

PAIRO is directly responsible for negotiating work hours with hospitals and universities, however many of the stakehold-ers with which PAIRO interacts have vested interests in the hours that residents work. As part of a larger strategic planning process to identify key issues and tactics, PAIRO developed a consensus strategy to help address the issue of work hours.

ConclusionPAIRO has taken numerous steps to ex-plore and develop a series of inter-related initiatives that will help ensure that work hours are not dealt with in isolation but are appropriately considered and addressed within the larger context of training and working conditions.

OverviewIn the last 25 years, resident work hours have garnered considerable attention. Most of the discussion has focussed on the total number of consecutive hours spent in a hospital providing clinical care. In consultation with our resident orga-nization, we determined that efforts to address working conditions must be ex-panded to include the entire residency experience and all associated challenges, not only number of hours worked.

PAIROOrganization

Members

UniversityHospital

Allied Healthcare

Organizations

PatientGovernment

PAIRO is an Investment in Residents and their Futures

MethodsResidents are elected each year from training sites across On-

tario to govern PAIRO’s direction and operations. PAIRO’s Gen-eral Council and Board of Directors consist of residents from a variety of disciplines, including family medicine, surgery, medicine, anesthesia, pediatrics, psychiatry and emergency medicine.

The Board of Directors in conjunction with focus groups from the General Council underwent a series of intensive fa-cilitated sessions throughout 2009-2010 to develop a plan that would maximize the likelihood of successful and optimal resi-dency experiences for its members. These meetings occurred over 10 days with each lasting from 3-6 hours. Between sessions information was collected, reviewed, and summarized for further reflection and refinement in subsequent sessions.

Environmental factors such as intra and inter-professional support and respect play a huge role in the residents’ experience of long working hours.

Working hours should not be considered in iso-lation from the larger issue of working conditions.

A Focus on Working Conditions

The method by which residents are trained needs to be re-visited in order to address both the quality of training and its current dependency on long work hours. There must be a shift from focusing on protecting the current training model within a framework of reduced hours to identifying and solving issues related to working conditions in general. The paradigm in which residents are best trained needs to be addressed in order to best realize improvements in work hours. Tackling the issue of work hours in isolation is not going to achieve optimal working conditions, nor optimal training.

A Focus on Training and Working Conditions

PAIRO champions the issues that create the conditions for Residents to be their best and

ensure optimal patient care

OPTIMAL TRAINING

Residents FEEL CONFIDENT TO SUCCEED

AND COMPETENT TO ACHIEVE EXCELLENCE

IN PATIENT CARE

OPTIMAL TRANSITIONS

Residents are able to make INFORMED CAREER CHOICES,

HAVE EQUITABLE ACCESS TO

PRACTICE OPPORTUNITIES,

AND AQUIRE PRACTICE MANAGEMENT SKILLS

for residency and beyond

OPTIMAL WORK CONDITIONS

Residents enjoy working and learning

in a SAFE, RESPECTFUL, AND HEALTHY

environment

CHAMPION BETTER CURRICULUM DESIGN

IMPROVE TEACHING

BUILD LEARNER MINDSET

STOP THE BULLY

BUILD RESIDENT RESPECT

BUILD RESIDENT VALUE

ORIENT AT ALL STAGES

COUNSEL ON CAREERS

PROMOTE EQUITABLE ACCESS

Residents appreciate the changes in work hours that have taken place over the past 15-20 years and feel they have a better work-life balance than their predecessors.

The reluctance of surgical residents to accept less work hours is related to educational concerns as well as an en-trenched culture perpetuated by both residents and staff alike.

The negotiated agreements between residents and hospitals must serve the larger vision of the resident organization.

A Focus on Issues Directly Relating to Work Hours

Fostering the love of Medicine

Chief resident workshops

We are Doctors training to be specialists

We don’t intimidate, harass, or devalue people

We lead the way we want to be lead

We support and mentor members of the team

We speak up when things negatively affect the workplace

We give and receive effective feedback

We are clear on expectations and aware of our limitations

We collaborate to get to better team and patient results

We foster our shared love of medicine

Our Resident Code

By Ceara McNeil, MD and Andrew Toren, MD

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