title: The Swedish duty hour enigma.
abstract: BACKGROUND
  The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this "the Swedish duty hour enigma." This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions?
  
  
  METHODS
  A case study was conducted at Karolinska University Hospital, Stockholm--an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research.
  
  
  RESULTS
  The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility.
  
  
  CONCLUSIONS
  According to Swedish residents' conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundberg
authors.forename: Hanna
authors.initials: H
authors.lastname: Frydén
authors.forename: Lars
authors.initials: L
authors.lastname: Kihlström
authors.forename: Jonas
authors.initials: J
authors.lastname: Nordquist
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000458:organization & administration / Q000592:standards; D006785:Hospitals, University / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D007407:Interviews as Topic; D007588:Job Satisfaction; D019982:Organizational Case Studies; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D036301:Qualitative Research; D011788:Quality of Life; D013548:Sweden; D013997:Time Factors; D000078329:Workforce