Abstract
BACKGROUND
Mandatory work hour limitations for residents began in July 2003. There has been little evaluation of the impact of the new limitations on Internal Medicine residency training.
OBJECTIVE
To assess Internal Medicine residents’ perceptions of the impact of work hour limitations on clinical experiences, patient care, resident education, and well-being, and their compliance with the limitations.
DESIGN AND PARTICIPANTS
Cross-sectional survey administered to Internal Medicine residents at 1 large U.S. teaching hospital.
MEASUREMENTS
Resident perceptions using 5-point Likert scales, and self-reported compliance. Exploratory factor analysis was used to identify underlying domains and develop scales.
RESULTS
The survey response rate was 85%. Five domains were identified by factor analysis: 1) clinical experience, 2) patient care and safety, 3) communication, 4) satisfaction with training, and 5) work–rest balance. Residents perceived work hour limitations to have a negative impact on clinical experience (mean scale score 1.84, 1 = negative, 5 = positive), patient care and safety (2.64), and communication domains (1.98). Effects on satisfaction (3.12) and work–rest balance domains (2.95) were more positive. Senior residents perceived more negative effects of work hour limitations than interns. Compliance was difficult; 94% interns and 70% residents reported violating work hour limits. Patient care and teaching duties were the main reasons for work hour violations.
CONCLUSIONS
This study suggests that the current work hour limitations may be having unintended negative consequences on residency training. Ongoing monitoring to evaluate the impact of program changes as a result of work hour regulation is crucial to improving residency training.
Similar content being viewed by others
References
Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington DC: National Academy Press; 2000.
Common Program Requirements. Accreditation Council for Graduate Medical Education. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursCommonPR.pdf. Accessed 12 August 2005.
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.
Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.
Laine C, Goldman L, Soukup JR, Hayes JG. The impact of a regulation restricting medical house staff working hours on the quality of patient care. JAMA. 1993;269:374–8.
Griffith CH, Wilson JF, Rich EC. Intern call structure and patient satisfaction. J Gen Intern Med. 1997;12:308–10.
Fletcher KE, Underwood W 3rd, Davis SQ, Mangrulkar RS, McMahon LF Jr, Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294(9):1088–100 (Sep 7).
Lin GA, Beck DC, Garbutt JM. Residents’ perceptions of the effects of work hour limitations at one large teaching hospital. Acad Med. 2006;81(1):63–7.
Gorsuch RL. Factor Analysis (2nd Ed.). Hillsdale, NJ: Lawrence Erlbaum Associates; 1983.
Boex JR, Leahy PJ. Understanding residents’ work: moving beyond counting hours to assessing educational value. Acad Med. 2003;78(9):939–44.
Whang EE, Mello MM, Ashley SW, Zinner MJ. Implementing resident work hour limitations: lessons from the New York experience. Ann Surg. 2003;237:449–55.
Weinstein DF. Duty hours for resident physicians—tough choices for teaching hospitals. N Engl J Med. 2002;347:1275–8.
Fletcher KE, Saint S, Mangrulkar RS. Balancing continuity of care with residents’ limited work hours: defining the implications. Acad Med. 2005;80(1):39–43.
Stoddard JJ, Kindig DA, Libby D. Graduate medical education reform. Service provision transition costs. JAMA. 1994;272(1):53–8.
Nuckols TK, Escarce JJ. Residency work-hours reform: a cost analysis including preventable adverse events. J Gen Intern Med. 2005;20:873–8.
Thorpe KE. House staff supervision and working hours. Implications of regulatory change in New York State. JAMA. 1990;263(23):3177–81.
Keating RJ, LaRusso NF, Kolars JC. Perceived impact of duty hours limits on the fragmentation of patient care: results from an academic medical center. Am J Med. 2005;118:788–93.
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.
Jagsi R, Kitch BT, Weinstein DF, Campbell EG, Hutter M, Weissman JS. Residents report on adverse events and their causes. Arch Intern Med. 2005;165:2607–13.
Daugherty SR, Baldwin DC, Rowley BD. Learning, satisfaction, and mistreatment during medical internship. JAMA. 1998;279:1194–9.
Irani JL, Mello MM, Ashley SW, Whang EE, Zinner MJ, Breen E. Surgical residents’ perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery. 2005;138:246–53.
Lund KJ, Alvero R, Teal SB. Resident job satisfaction: one year of duty hours. Am J Obstet Gynecol. 2005;193:1823–6.
Cohen-Gadol AA, Piepgras DG, Krishnamurthy S, Fessler RD. Resident duty hours reform: results of a national survey of the program directors and residents in neurosurgery training programs. Neurosurgery. 2005;56(2):398–403.
Saunders DL, Kehoe KC, Rinehart VH, Berg BW. Self-reporting of internal medicine house staff work hours. Hawaii Med J. 2005;64(1):14–6.
Henry K, Campbell S, Maki M. A comparison of observed and self-reported compliance with universal precautions among emergency department personnel at a Minnesota public teaching hospital: implications for assessing infection control programs. Ann Emerg Med. 1992;21(8):940–6.
Acknowledgments
The authors wish to thank Steven Gregorich, PhD for his expert statistical advice and assistance, and Daniel Goodenberger, MD and Megan Wren, MD for their support of the project. This study was supported by a Mentors in Medicine grant from the Washington University School of Medicine and by a grant from the Partnerships for Quality Education. These data were presented at the Society of General Internal Medicine Annual Meeting on April 29, 2006.
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Lin, G.A., Beck, D.C., Stewart, A.L. et al. Resident Perceptions of the Impact of Work Hour Limitations. J GEN INTERN MED 22, 969–975 (2007). https://doi.org/10.1007/s11606-007-0223-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-007-0223-3