Original scientific article
Should All Duty Hours Be the Same? Results of a National Survey of Surgical Trainees

https://doi.org/10.1016/j.jamcollsurg.2009.02.053Get rights and content

Background

Although duty hours regulations (DHR) were introduced as a measure to improve patient safety and graduate medical education, new evidence suggests that the opposite might be happening. This study was designed to assess surgery resident perceptions of the impact that DHR have had on their education, the number of hours they believed would be ideal for their training, and to evaluate the effect of seniority on these opinions.

Study Design

An Internet-based survey was electronically distributed to all Resident and Associate members of the American College of Surgeons.

Results

Of 599 respondents, 247 (41%) believed that DHR were an important barrier to their education, and 266 (44%) believed that the ideal work week should have 80 to 100 hours. These two opinions were highly correlated, and were increasingly voiced with increased resident experience. Senior residents were more likely to view DHR as an important barrier to their education whether or not they were general surgery residents or were trained in small, medium, or large programs.

Conclusions

A large subset of surgery residents, particularly senior residents, considered DHR an important barrier to their education and expressed a desire to work longer hours than restrictions allow. These findings suggest that strict and uniform DHR do not allow for optimal training of residents at different levels who have disparate educational goals and needs. Introducing some flexibility into senior residents' limitations should be considered.

Section snippets

Methods

An Internet-based survey was created using EZ-Surveymaker, a commercially available software package. Created by the Resident and Associate Society of the American College of Surgeons (RAS-ACS), this assessment was part of a larger survey of resident opinions on the impact of a broad range of factors in their education (see Appendix, available online). Because no validated surveys exist to assess resident opinions on their education, a literature review was conducted to identify specific

Results

Five hundred ninety-nine of 8,172 RAS-ACS residents and Fellows responded to our survey (7.3%). Their demographic information is listed in Table 1 and is representative of RAS-ACS membership.

Forty-one percent (n = 246) of respondents stated that DHR were a considerable (n = 70; 11.7%) or moderate (n = 176; 29.6%) barrier to their education. Fewer than one-third (n = 186; 31%) of residents reported that their education was not hindered by DHR. Another 27% (n = 164) stated that the DHR were a

Discussion

The major finding of our study is that 4 years after implementation of DHR, surgery residents remained ambivalent about the impact that these regulations had on their training and about the optimal number of hours for their training. In addition, as surgery residents approached graduation, they were increasingly likely to view DHR as a detriment to their education, and to believe that the optimal number of weekly work hours was >80. These findings are even more meaningful considering that many

Author Contributions

Study conception and design: Moalem, Cherr, Freiburg, Brewster, James

Acquisition of data: Moalem, Freiburg, Brewster, James

Analysis and interpretation of data: Moalem, Salzman, Ruan, Farkas

Drafting of manuscript: Moalem, Salzman, Ruan, Cherr, Freiburg, Farkas, Brewster, James

Critical revision: Moalem, Salzman, Ruan, Cherr, Freiburg, Farkas, Brewster, James

Acknowledgment

We would like to thank Peg Haar and Howard Tanzman for their assistance with the distribution of the survey and compilation of the results, and Wendy Husser for her editorial review.

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