2006 APDS Spring meetingThe 80-Hour Resident Workweek Does Not Adversely Affect Patient Outcomes or Resident Education
Introduction
Resident work hour restrictions were first implemented in New York State in the late 1980s after the death of a young woman whose demise was presumed to be due to medical errors committed by sleep-deprived resident physicians.1, 2 It was not until July 2003, however, that the Accreditation Council for Graduate Medical Education (ACGME) responded to intense public pressure by imposing nationwide restrictions in work hours for resident physicians.
Since the implementation of these new work hour restrictions, there has been controversy over the validity of the reforms and the threat they might pose to resident education. Such concerns are especially acute in relation to surgery residency programs, where long duty hours have historically been deemed crucial for the development of sound surgical judgment.3 The purpose of this study was to comprehensively evaluate the effects of the restricted hours on several parameters, including (1) patient outcomes, as measured by trauma morbidity and mortality rates; (2) surgical resident education as determined by operative volumes, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery examination pass rates; and (3) the institutional cost of complying with resident duty hour restrictions.
Section snippets
Program Structure
The Department of Surgery at Harbor-UCLA Medical Center has a 6-year residency program in general surgery consisting of 5 clinical years and 1 research year. The program is approved to graduate 4 categorical residents per year. In addition to the categorical residents, the program accepts 8 non-designated preliminary residents at the postgraduate year PGY-1 and PGY-2 levels and 6 designated preliminary residents at the PGY-1 level.
Changes in the Surgery Residency Program
In anticipation of the new duty hour restrictions, numerous
Work Hours
The mean call schedule frequency decreased from once every 4.8 nights to once every 6.4 nights (p < 0.0001) from Period 1 to Period 2.
Patient Outcome
Over the entire 7-year study period, 11,518 trauma patients were treated at Harbor-UCLA Medical Center. The average annual trauma patient volume significantly increased from 1510 patients in Period 1 to 1981 patients in Period 2 (p 0.01). The mean injury severity score (ISS) increased from 7.9 to 9.6 (p < 0.0001). There was an increase in the percentage of
Discussion
There has been considerable concern that limiting resident work hours might jeopardize the quality of general surgery training. Reasons cited include loss of continuity of care, decreased patient exposure, and inability to develop appropriate judgment. These factors could eventually translate into less well-qualified practicing surgeons. However, this study demonstrates that despite more limited resident work hours, several parameters that are considered surrogate measures of resident
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