2004 APDS spring meeting: Part 2The 80-hour work week: Will we have less-experienced graduating surgeons?
Introduction
The Accreditation Council for Graduate Medical Education (ACGME) instituted the “80-hour work week” on July 1, 2003. Despite preemptive notice, surgical residencies have had difficulty incorporating the regulations while concomitantly maintaining solid resident education. The ramifications of hour restrictions are complicated with regard to financial factors, work force reductions, and the provision of a constricting environment to train general surgeons.
The major problem with the adjustment to the hour restrictions is not so much limiting residents to 80 hours per week as it is molding those hours into the time frames required. Challenges are evident in situations when residents are required to leave the hospital in the face of educational opportunities, such as family discussions, attending bedside rounds, and didactic conferences. Through the trials of adaptation to the 80-hour work week, it becomes clear that maintaining the production of well-rounded, mature, and adept general surgeons is the most critical initiative.
We have been concerned with the effect of hour restrictions on resident operative volume. Prospective trials that address this issue have not been published despite its centrality to the maturation of general surgeons. We hypothesized that surgical residents at Mount Carmel would miss a significant number of operations with the implementation of the 80-hour work week. In addition, we anticipated that the implementation of a night rotation would decrease the operative loss.
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Materials and methods
We began compliance with the ACGME regulations on July 1, 2002, and data collection began on September 1, 2002. Postgraduate Year I to IV residents recorded operations that they would have performed on post in-house call days from September 1, 2002 to March 31, 2004. The Mount Carmel intranet was used to obtain data. Recorded operations were categorical cases in which the resident would have participated as the junior surgeon or rarely as first assistant.
From September 1, 2002 to March 30,
Results
The average number of missed operations for successive postgraduate years is displayed in TABLE 1, TABLE 2, TABLE 3. The data for the pre-night rotation (7-month period) were extrapolated to 12 months by dividing the number of missed operations by 7 months and multiplying the result by 12 months (Table 1). The post-night rotation is divided to account for the end of the academic year (Table 2). The number of missed operations for pre- and post-night rotation periods are displayed (Table 3). The
Discussion
The Accreditation Council for Graduate Medical Education’s institution of the 80-hour work week has set forth significant challenges for general surgery residency programs across the United States. The immediate challenge facing programs stems solely from a decrease in work force. It becomes painstakingly clear that many resident obligations are “service-oriented” and can be covered by nonphysician practitioners. Redefining resident responsibilities and clarifying which of these
Acknowledgments
The authors acknowledge the editorial assistance of Lisa Farina.
References (4)
Crisis in surgical education
J Am Coll Surg
(2001)Residency reform Halstead-style
J Am Coll Surg
(2003)
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