The scope of duty hour–associated residency structure modifications

doi:10.1016/j.ajog.2005.07.053

American Journal of Obstetrics and Gynecology

Volume 194, Issue 1, January 2006, Pages 282-288

https://doi.org/10.1016/j.ajog.2005.07.053 Get rights and content

Objective

The purpose of this study was to characterize the duty hours–associated modifications made to the educational and patient care structure of obstetrics and gynecology residency programs, and the relationship of these modifications to residency program setting and size.

Study design

A survey of accredited obstetrics and gynecology residency programs in the United States (excluding New York State) was performed between June 21st and July 16th, 2004. Program representatives were queried on the difficulty encountered in complying with each of the 6 components of the ACGME common duty hour requirements and the prevalence of residency modifications affecting the educational and patient care structure.

Results

Fifty-eight percent (123/211) of the study population completed the questionnaire. Ensuring a minimum 10-hour rest period between shifts was rated the most difficult requirement. Ninety-eight percent of respondents reported various types of modifications to program structure, including modification of on-call structure (94%), redistribution of responsibilities among resident levels (85%), modification of resident participation in patient care processes (80%), and modification of resident assignments to clinical services (75%). A minimum of 38% of programs reported reductions in resident participation in patient care, regardless of clinical service type or care setting. The prevalence of hiring attending physicians was significantly higher among non–university-based programs (18%), compared to university-based programs (3%, P = .007).

Conclusion

Duty hour–related changes have resulted in near universal program modifications. One third of programs have made modifications that have resulted in a decrease in the available clinical experiences for residents.

Section snippets

Survey design

For the purpose of this study, we designed a multiphase questionnaire. A preliminary section first queried participants on the relative difficulty encountered in complying with each of the 6 components of the ACGME common duty-hour requirements. Response options were based on a 5-point Likert-type scale (1 = not difficult; 5 = extremely difficult). Additionally, participants were queried on whether they had modified any aspect of their program structure in order to achieve compliance.

Results

We assessed 254 residency programs for study participation. Our eligible study population was limited to 211 programs after exclusions (Figure 1). At the conclusion of the enrollment period, representatives from 123 eligible programs had completed the questionnaire in its entirety, yielding an overall response rate of 58%. No significant differences were noted in the characteristics of the participating and nonparticipating programs (Table I).

Of the 6 common duty-hour requirements, compliance

Comment

Our study confirms that the ACGME duty-hour limitations resulted in a near universal need for modification of program structure among obstetrics and gynecology residencies. Among the 6 components of ACGME common duty-hour requirements, ensuring 10 hours off between periods of duty was reported to be the most difficult compliance issue. Programs pursued a diverse range of approaches to achieve compliance, which included modification of both clinical and non-clinical curricular components. In

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Dr Ramsey's effort was supported by NIH grant number K12-HD01402.

Presented at the 2005 Association of Professors of Obstetrics and Gynecology Annual Meeting in Salt Lake City, Utah, March 6th, 2005.

Reprints not available from the authors.

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EducationThe scope of duty hour–associated residency structure modifications

Objective

Study design

Results

Conclusion

Section snippets

Survey design

Results

Comment

A word from the president: responding to a changing world

AAMC Reporter

Education
The scope of duty hour–associated residency structure modifications