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Resident Perceptions of the Impact of Work Hour Limitations

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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.

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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.

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Correspondence to Grace A. Lin MD.

Appendix

Appendix

Table 5 Mean (SD) Individual Question Scores

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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

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  • DOI: https://doi.org/10.1007/s11606-007-0223-3

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