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

Moalem, Jacob; Salzman, Peter; Ruan, Daniel T.; Cherr, Gregory S.; Freiburg, Carter B.; Farkas, Rachel L.; Brewster, Luke; James, Ted A.

doi:10.1016/j.jamcollsurg.2009.02.053

« Previous Next »Journal of the American College of Surgeons
Volume 209, Issue 1 , Pages 47-54.e2, July 2009

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

Jacob Moalem, MD
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
- Correspondence address: Jacob Moalem, MD, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642
Peter Salzman, PhD
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
Daniel T. Ruan, MD
- Surgery, Social and Preventive Medicine, Brigham and Women's Hospital, Boston, MA
Gregory S. Cherr, MD, FACS
- State University of New York at Buffalo Medical Center, Buffalo, NY
Carter B. Freiburg, MD
- Department of Surgery, University of Vermont Medical Center, Burlington, VT
Rachel L. Farkas, MD
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
Luke Brewster, MA, MD
- Department of Surgery, Loyola University Medical Center, Maywood, IL
Ted A. James, MD, FACS
- Department of Surgery, University of Vermont Medical Center, Burlington, VT

Received 6 January 2009; received in revised form 9 February 2009; accepted 12 February 2009. published online 01 May 2009.

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.

Abbreviations and Acronyms: DHR, duty hour regulations, GS, general surgery, NGS, non-general surgery residents, RAS-ACS, Resident and Associate Society of the American College of Surgeons