title: Monitoring and improving resident work environment across affiliated hospitals: a call for a national resident survey.
abstract: OBJECTIVE
  To assess, monitor, and improve resident work environment and enhance compliance with Accreditation Council for Graduate Medical Education (ACGME) institutional requirements among the five Loma Linda University-affiliated hospitals using an annual survey.
  
  
  METHODS
  From 2001 to 2005, residents completed an anonymous questionnaire assessing each hospital's educational and work environment regarding clinical services, attending physicians, learning opportunities, resident environment, and coordination of care. Resident perceptions were compared across hospitals and residency programs.
  
  
  RESULTS
  A total of 2,399 resident surveys were collected during a five-year period from 500 residents in 43 different residency programs. The overall response rate was 88%. Residents perceived deficiencies in clinical services at the Veterans Affairs (VA) hospital. After focused improvement efforts directed to VA clinical services, serial data showed significant improvements in residents' perceptions of nursing, phlebotomy, radiology, social work, case management, and overall clinical services in subsequent years (P < .001). The survey data identified resident concerns at other affiliated hospitals and were instrumental in persuading hospital administrators to improve the university hospital resident lounge and computerized lab results at a county hospital. Resident perceptions improved in subsequent years after the changes were made (P < .001). The survey also suggested improvements in residency-specific program educational issues.
  
  
  CONCLUSIONS
  A survey across five consecutive years involving five affiliated hospitals provided local benchmarks and serial data to monitor and significantly improve resident perceptions of their work environment and ensured optimal compliance with ACGME institutional requirements. These results and the data of others support the idea of an expanded, national resident survey.
authors.affiliation: VA Loma Linda Healthcare System, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California 92357, USA. john.byrne@med.va.gov
authors.forename: John M
authors.initials: JM
authors.lastname: Byrne
authors.forename: Lawrence K
authors.initials: LK
authors.lastname: Loo
authors.forename: Dan
authors.initials: D
authors.lastname: Giang
mesh_terms: D019985:Benchmarking; D002140:California; D003625:Data Collection; D004503:Education, Medical, Graduate / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards*; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency; D017132:Workplace