2004 APDS spring meeting: Part 2Meeting the 80-hour work week requirement: What did we cut?
Introduction
In implementing a work week of no more than 80 hours for all training programs, the arduous deliberation of ACGME with exhaustive coverage of all aspects has been well publicized in their website and bulletins for the past several years. The basic tenet, that reducing physical fatigue and eliminating noneducative tasks may lead to better learning efficiency, fewer errors, and more fulfilling residents, can only be tested after implementation. Considering the differences in specialties, size of programs, types of institutions, and the divergent needs of junior versus senior residents, a “one size fits all” rule would be difficult to put into practice. In particular, for small programs already devoid of noneducational chores, reduction in educational components is an unavoidable sequelae of shorter hours in the hospital. Since the rule has been in effect, many solutions, ranging from reengineered schedules, reduced patient volume, or more manpower (residents or physician assistants), have been devised, but none without major drawbacks.1, 2, 3 In this study, we outline our system of meeting with the rule and analyze the unavoidable side effects, and we report on the outcome of the effort—how the residents feel about the change with respect to work satisfaction and physical fatigue.
Section snippets
Baseline information
In a surgical training program graduating 2 residents per year, with 3 nondesignated preliminary residents, the baseline work hours/week averaged 97 ± 12. The main hospital is a 250-bed community hospital with a level II trauma center. The program has been in good accreditation standing and has no citations in the recent review. The resident manpower has been augmented by a surgical assistant team of 5, with work assigned by the chief resident for full integration. Residents do not perform
Results
As shown in Table 1, the new schedule complied with the 80-hour week for all residents, the hour reduction being less for the juniors. The maximum consecutive hours was reduced by sending residents home at the end of the call duty. For junior residents, reduction in peripheral external rotations has the most direct impact, whereas the other components (operations, consultation, continuity of care, and conferences), all of which are significantly reduced, seemed to affect the senior residents
Discussion
Prior to July 2003, most surgical programs outside of New York State did not meet the new accreditation requirement nor had any systematic tracking of work hours been used. Current systems of meeting with the new rule fall into 3 categories: increasing manpower (adding more residents or physician assistants), reducing work load (limiting teaching service size), and redeployment of existing manpower (eg, “night float” system and other nontraditional scheduling).1, 3 In all of them, some
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