Perceived impact of duty hours regulations: a survey of residents and program directors (original) (raw)
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BMC medical education, 2017
The Accreditation Council for Graduate Medical Education (ACGME) implemented revisions to resident duty hour requirements (DHRs) in 2011 to improve patient safety and resident well-being. Perceptions of DHRs have been reported to vary by training stage and specialty among internal medicine and general surgery residents. The authors explored perceptions of DHRs among all residents at a large academic medical center. The authors administered an anonymous cross-sectional survey about DHRs to residents enrolled in all ACGME-accredited core residency programs at their institution. Residents were categorized as medical and pediatric, surgery, or other. In total, 736 residents representing 24 core specialty residency programs were surveyed. The authors received responses from 495 residents (67%). A majority reported satisfaction (78%) with DHRs and believed DHRs positively affect their training (73%). Residents in surgical specialties and in advanced stages of training were significantly l...
American Journal of Surgery, 2006
Background: This study examined how surgical residents and faculty assessed the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions. Methods: Questionnaires were administered in 9 general-surgery programs during the summer of 2004; response rates were 63% for faculty and 58% for residents (N ϭ 259). Questions probed patient care, the residency program, quality of life, and overall assessments of the duty-hour restrictions. Results include the means, mean deviations, percentage who agree or strongly agree with the hour restrictions, and significance tests. Results: Although most support the restrictions, few maintain that they improved surgical training or patient care. Faculty and residents differed (P Յ .05) on 16 of 21 items. Every difference shows that residents view the restrictions more favorably than faculty. The sex of the resident shaped the magnitude of the gap for 11 of 21 items. Conclusions: Few believe that duty-hour restrictions improve patient care or resident training. Residents, especially female residents, view the restrictions more favorably than faculty.
American Journal of Obstetrics and Gynecology, 2006
Objective: The purpose of this study was to characterize residency program director baseline perceptions regarding the effect of resident duty hour limitations on key components of the graduate medical education environment. Study design: This was a survey of directors of accredited obstetrics and gynecology residency programs in the United States (excluding New York State) between June 21st and July 16th, 2004. Participants were queried on views regarding the need for duty hour limitations, and the perceived effect of these changes on various issues related to the residency environment. Results: Fifty-eight percent (123/211) of the study population completed the questionnaire. Seventy-one percent of respondents supported duty hour restrictions, 19% opposed restrictions, and 10% were undecided. Forty-one percent of respondents preferred a maximum duty hour limitation of 80 hrs/wk or less, 55% preferred one at least 90 hrs/wk, and 4% preferred no upper limit. A significantly greater proportion of female program directors supported limits O80 hrs/ wk than males (73% vs 53%, P = .04). A majority of participants believed resident education, surgical skills, and work ethic have been negatively impacted by the limitations, while patient safety and the overall quality of patient care have remained unchanged or declined, and resident well-being has improved. Opposition to duty hour regulations and a preference for higher limits was associated with a higher prevalence of negative impressions regarding the impact of duty hour regulations on the residency environment. Conclusion: Variations in current opinions regarding the impact of residency duty hour restrictions reflect ongoing bias in those most influential to resident education.
A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery
Annals of Surgery, 2014
Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
A Systematic Review of the Affects of Resident Duty Hour Restrictions in Surgery
Annals of Surgery, 2014
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
Strategies to Accommodate Resident Work-Hour Restrictions: Impact on Surgical Education
Journal of Surgical Education, 2011
The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education.
The impact of the resident duty hour regulations on surgical patients’ perceptions of care
Patient Experience Journal
Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident's educational experience, patient care quality, and patients' satisfaction and perceptions. A pre retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic-June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, a hour regulations. While the odds of patients rating related to time spent, kept informed, and friendliness/ courtesy) were higher rating "very good", the overall rating of quality care improved post increased interaction of patients with other hospital personnel. To improve patient satisfacti perceptions, initiatives such as workload balancing, hand for care providers are recommended. Finally, residency programs and institutions need to develop strategies for implementation of current and future ACGME duty hour regulations so as to balance patient safety, patient percep and resident well-being.
Should All Duty Hours Be the Same? Results of a National Survey of Surgical Trainees
Journal of the American College of Surgeons, 2009
BACKGROUND: Although duty hours regulations (DHR) were introduced as a measure to improve patient safety and graduate medical education, new evidence suggests that the opposite might be happening. This study was designed to assess surgery resident perceptions of the impact that DHR have had on their education, the number of hours they believed would be ideal for their training, and to evaluate the effect of seniority on these opinions. STUDY DESIGN: An Internet-based survey was electronically distributed to all Resident and Associate members of the American College of Surgeons.