Selected Manuscripts from the 2004 CREOG and APGO Annual Meeting
Impact of work hour restrictions on resident case experience in an obstetrics and gynecology residency program

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Objective

The purpose of this study was to evaluate senior resident case experience before and after enactment of work hour restrictions.

Study design

Obstetrics and gynecology experience from 2 postgraduate year 4 classes were evaluated before and after adoption of work hour restrictions. Data were limited to experience obtained during the fourth year of residency. Data were analyzed with the 2-sample t test and Wilcoxon rank sum test, and adjusted for changes in institutional procedural volume.

Results

There were significant decreases in resident experience in total abdominal hysterectomy (P = .018), procedures for genuine stress urinary incontinence (P = .004), and hysteroscopy (P = .006). Decreases were seen in resident experience in vaginal birth after cesarean section (P = .011), primary cesarean section (P = .31), and vacuum delivery (P = .007), despite increase in institutional volume.

Conclusion

Work hour restrictions have had impact on resident case experience in obstetrics and gynecology. Variance in institutional case numbers account for only some of these changes.

Section snippets

Material and methods

In this retrospective cohort study, we evaluated surgical and procedural case experience of fourth-year residents in the CWRU-MHMC/CCF residency program in obstetrics and gynecology. Exemption from Institutional Review Board approval was obtained [Section 46.101(b)(1) of the Federal Regulations].

The CWRU-MHMC/CCF residency program in obstetrics and gynecology is an integrated program. Residents' rotations take place both at MHMC (an urban, 750-bed tertiary care referral center, serving a

Results

Obstetrics and gynecology experience from 2 PGY4 classes was evaluated (5 residents per class). Comparison of work hours before (average 84 duty hours per week) and after (average 66 duty hours per week) adoption of work hour restrictions revealed a decrease of 21.4%.

Evaluation of gynecologic experience before and after work hour restrictions (2001-2002 and 2002-2003, respectively) revealed both increases and decreases in cases performed by residents (Table II). There was significant decrease

Comment

In 1989, the New York State Legislature enacted New York State Code 405 in response to the death of a patient in a New York City hospital.7 It established regulations on working hours and scheduled time off for certain members of the medical staff and postgraduate trainees of hospitals in New York State. Stiff fines were established for those hospitals cited for noncompliance.8 The ACGME began to develop duty hours standards for some specialties as early as the 1980s. In 2001, the ACGME

References (15)

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Presented at the 2004 CREOG and APGO Annual Meeting, Lake Buena Vista, Fla, March 3-6, 2004.

Reprints not available from the authors.

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