Effects of limited work hours on surgical training (original) (raw)
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Current Surgery, 2005
PURPOSE: To assess the impact of resident work hour limitations on how surgical residents feel about their training, patient care, and their overall well-being. METHODS: Three surveys were administered to 28 categorical surgery residents before and after implementation of the Accreditation Council on Graduate Medical Education (ACGME) work hour restrictions. The surveys consisted of a Beck Depression Inventory II (BDI-II), a SF-36 Health Status Profile (SF-36), and a custom 20-item Likert scale survey. The results of the surveys were then compiled to evaluate any significant changes in resident attitudes. RESULTS: Only minor differences were noted in the BDI-II and SF-36. The Likert scale survey showed no differences in attitude toward resident education, faculty interaction, operating room exposure, patient care, or continuity. Significant improvements were noted in the feelings of residents toward time for reading, rest, time with family, and socializing. CONCLUSIONS: Although a great deal of concern has existed about the impact of work hour limitations on surgery resident training, residents feel their training has not been affected significantly. Work hour restrictions have, however, had a positive impact on the lives of surgery residents outside of the hospital.
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.
Implementation and Evaluation of a New Surgical Residency Model
Journal of the American College of Surgeons, 2007
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements prompted program directors to rethink the organizational structure of their residency programs. Many surgical educators have expressed concerns that duty-hour restrictions would negatively affect quality of resident education. This article summarizes evaluation research results collected to study the impact of our reengineered residency program designed to preserve important educational activities while meeting duty-hour accreditation requirements. STUDY DESIGN: The traditional residency structure was redesigned to include a mixture of apprenticeship, small team, and night-float models. Impact evaluation data were collected using operative case logs, standardized test scores, quality assurance data, resident perception surveys, a faculty survey, and process evaluation measures.
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 80-Hour Work Guidelines and Resident Survey Perceptions of Quality
Journal of Surgical Research, 2006
We hypothesized that resident fatigue error should improve, related to well-rested trainees as a direct cause/effect benefit. However, patient hospital care quality is multifactorial, so impact on patient care quality by changing only one variable for a single caregiver group was unknown. Design and participants. Convenience samples of 156 residents from three surgical specialties were administered a questionnaire in early 2004 addressing perceptions of patient care quality before and after the 80-h workweek. Additionally, residents recently under work-hour restrictions (Newly Restricted, NR) were compared to New York state trainees already regulated by work-hour restrictions (Previously Restricted, PR). Setting. Surgical residency training venues. Main outcome measure. Survey results; the level of significance for all tests was 0.05. Results. The participation response rate was 94.5%. Eighty-eight percent of respondents indicated by survey subjective impression that patient care quality was either unchanged (63%) or worse (26%) due to work-hour restrictions (P ؍ 0.003). PR residents were more likely than NR residents to report unchanged or worse quality of care (P ؍ 0.015). Residents overall did perceive improvement in some types of error with fewer fatigue-related errors (P < 0.001), e.g., medication (P < 0.001), judgment (P ؍ 0.001), and dexterity (P ؍ 0.013), subsequent to work-hour restrictions. However, more errors were perceived related to continuity of care (P < 0.001), miscommunication (P ؍ 0.001), and cross-coverage availability (P ؍ 0.001). Conclusions. Despite an expected perception of improvement in fatigue-related errors, most participants (particularly PR residents) reported impressions that patient care quality had remained unchanged or had declined under the work-hour restrictions. Unresolved challenges with continuity of care, miscommunication, and cross-coverage availability are possible explanations. Mere work-hour reduction does not appear to improve patient care quality automatically nor to decrease the possibility for some types of error. Process interventions that specifically target trainee sign-out coverage constraints as part of a global reassessment will be important for future attempts to enhance quality hospital patient care.