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Internal medicine residents’ clinical and didactic experiences after work hour regulation

A survey of chief residents

  • Original Articles
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Abstract

BACKGROUND: Work hour regulations for house staff were intended in part to improve resident clinical and educational performance.

OBJECTIVE: To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education.

DESIGN: Cross-sectional mail survey.

PARTICIPANTS: Chief residents at all accredited U.S. internal medicine residency programs outside New York.

MEASUREMENTS AND MAIN RESULTS: The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4,P=.12), but 56% of programs reported a decrease in intern attendance at educational activities.

CONCLUSIONS: In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents’ inpatient clinical experience. Hours allotted to educational activities did not change: however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.

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References

  1. The Patient and Physician Safety Act of 2001, H. R. 3236, 107th Congress, First Session, 2001.

  2. Petition to the Occupational Safety and Health Organization requesting that limits be placed on hours worked by medical residents (HRG Publication #1570). Available at: http://www.citizen.org/publications/release.cfm?ID=6771. Accessed March 6, 2006.

  3. Accreditation Council for Graduate Medical Education. Common program requirements (resident duty hours). Available at: http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursCommonPR.pdf. Accessed March 6, 2006.

  4. Accreditation Council for Graduate Medical Education. The ACGME’s approach to limit resident duty hours 12 months after implementation: a summary of achievements. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursummary2003-04.pdf. Accessed March 6, 2006.

  5. Accreditation Council for Graduate Medical Education. Statement of justification/impact for the final approval of common standards related to resident duty hours. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_impactStatement.pdf. Accessed March 6, 2006.

  6. Wilson MC. In pursuit of optimal duty hours and resident experiences. J Gen Intern Med. 2004;19:97–8.

    Article  PubMed  Google Scholar 

  7. Fletcher KE, Underwood W III,Davis SQ, Mangrulkar RS, McMahon LF Jr,Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294:1088–100.

    Article  PubMed  CAS  Google Scholar 

  8. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165:2601–6.

    Article  PubMed  Google Scholar 

  9. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.

    Article  PubMed  Google Scholar 

  10. Lin GA, Beck DC, Garbutt JM. Residents’ perceptions of the effects of work hour limitations at a large teaching hospital. Acad Med. 2006;81:63–7.

    Article  PubMed  Google Scholar 

  11. Vidyarthi AR, Katz PP, Wall SD, Wachter RM, Auerbach AD. Impact of reduced duty hours on residents’ educational satisfaction at the University of California, San Francisco. Acad Med. 2006;81:76–81.

    Article  PubMed  Google Scholar 

  12. New York Health Code, 10 NYCRR Sect 405.4 (1989).

  13. Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse events. J Gen Intern Med. 2005;20:873–8.

    Article  PubMed  Google Scholar 

  14. Barden CB, Specht MC, McCarter MD, Daly JM, Fahey TJ III. Effects of limited work hours on surgical training. J Am Coll Surg. 2002;195:531–8.

    Article  PubMed  Google Scholar 

  15. Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA. Effect of the 80-hour workweek on resident burnout. Arch Surg. 2004;139:933–8; discussion 8–40.

    Article  PubMed  Google Scholar 

  16. Hassett JM, Nawotniak R, Cummiskey D, et al. Maintaining outcomes in a surgical residency while complying with resident working hour regulations. Surgery. 2002;132:635–9; discussion 9–41.

    Article  PubMed  Google Scholar 

  17. Mendoza KA, Britt LD. Resident operative experience during the transition to work-hour reform. Arch Surg. 2005;140:137–45.

    Article  PubMed  Google Scholar 

  18. Spencer AU, Teitelbaum DH. Impact of work-hour restrictions on residents’ operative volume on a subspecialty surgical service. J Am Coll Surg. 2005;200:670–6.

    Article  PubMed  Google Scholar 

  19. Johnson T. Limitations on residents’ working hours at New York teaching hospitals: a status report. Acad Med. 2003;78:3–8.

    Article  PubMed  Google Scholar 

  20. FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78:84–9.

    Article  PubMed  Google Scholar 

  21. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–48.

    Article  PubMed  CAS  Google Scholar 

  22. Lim KG, Dunn WF, Klarich KW, Afessa B. Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions. Crit Care Med. 2005;33:1534–7.

    Article  PubMed  Google Scholar 

  23. Reader DW, Spigos DG, Bennett WF, Mueller CF, Vaswani KK. The graveyard shift: experience with a night float system. Emerg Radiol. 2002;9:82–7.

    PubMed  Google Scholar 

  24. Buff DD, Shabti R. The night float system of resident on call: what do the nurses think? J Gen Intern Med. 1995;10:400–2.

    Article  PubMed  CAS  Google Scholar 

  25. Trontell MC, Carson JL, Taragin MI, Duff A. The impact of the night float system on internal medicine residency programs. J Gen Intern Med. 1991;6:445–9.

    Article  PubMed  CAS  Google Scholar 

  26. Wong JG, Holmboe ES, Huot SJ. Teaching and learning in an 80-hour work week: a novel day-float rotation for medical residents. J Gen Intern Med. 2004;19:519–23.

    Article  PubMed  Google Scholar 

  27. Parekh VI, Sharpe B, Fletcher KE, Cornia P, Vidyarthi A. The impact of resident work hours limits on internal medicine residents’ continuity clinic experience. J Gen Intern Med. 2005;20:165.

    Article  Google Scholar 

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Authors and Affiliations

  1. VA Connecticut Healthcare System, West Haven, CT, USA

    Leora I. Horwitz MD

  2. Robert Wood Johnson Clinical Scholar, Yale University School of Medicine, IE-61 SHM, PO Box 208088, 06520-8088, New Haven, CT

    Leora I. Horwitz MD & Harlan M. Krumholz MD, SM

  3. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Leora I. Horwitz MD, Harlan M. Krumholz MD, SM, Stephen J. Huot MD, PhD & Michael L. Green MD, MSc

Authors
  1. Leora I. Horwitz MD
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  2. Harlan M. Krumholz MD, SM
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  3. Stephen J. Huot MD, PhD
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  4. Michael L. Green MD, MSc
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Corresponding author

Correspondence to Leora I. Horwitz MD.

Additional information

Dr. Horwitz is supported by the Department of Veterans Affairs and the Robert Wood Johnson Clinical Scholars Program, which had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication.

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Horwitz, L.I., Krumholz, H.M., Huot, S.J. et al. Internal medicine residents’ clinical and didactic experiences after work hour regulation. J GEN INTERN MED 21, 961–965 (2006). https://doi.org/10.1007/BF02743145

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  • DOI: https://doi.org/10.1007/BF02743145

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