1. 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.
Results
The 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
Background
Resident 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.
Conclusion
PAIRO 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.
Overview
In 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.
PAIRO
Organization
Members
University
Hospital
Allied
Healthcare
Organizations
PatientGovernment
PAIRO is an Investment in Residents
and their Futures
Methods
Residents 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
CONFIDENTTO SUCCEED
AND COMPETENTTO
ACHIEVE EXCELLENCE
IN PATIENT CARE
OPTIMAL
TRANSITIONS
Residentsareable
tomakeINFORMED
CAREERCHOICES,
HAVE EQUITABLE
ACCESSTO
PRACTICEOPPORTUNITIES,
AND AQUIRE PRACTICE
MANAGEMENT SKILLS
forresidencyandbeyond
OPTIMAL
WORK CONDITIONS
Residents enjoy
working and learning
ina SAFE,
RESPECTFUL,ANDHEALTHY
environment
CHAMPION BETTER
CURRICULUM DESIGN
IMPROVETEACHING
BUILD LEARNER MINDSET
STOPTHE BULLY
BUILD RESIDENT RESPECT
BUILD RESIDENTVALUE
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 AndrewToren, MD
ICRE poster 2010print.indd 1 9/23/10 1:39:43 PM