Surgical Residents Lament Work Hour Limits

A new survey suggests that efforts to reduce residents' sleep deprivation and stress with mandatory reductions in work hours have not been popular with hospital attending staff, or the residents themselves.

Researchers at Rhode Island Hospital (Providence, USA) conducted a 20-question electronic survey administered six months after implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) regulations to 123 participating institutions. The total sample included 1,013 voluntarily participating residents in general surgery and surgical specialties. The main outcomes were the residents' perceptions of changes in education, patient care, and quality of life after institution of the ACGME duty hour regulations, and their compliance with these rules.

The results showed that most surgical residents indicated that education, preparation for senior roles, and work schedules are worse after implementation of the 2011 regulations. They reported no change in supervision, safety of patient care, or amount of rest. And although quality of life was perceived as better for interns, most residents believe that it is worse for senior residents. A majority reported increased handoffs and a shift of junior-level responsibilities to senior residents. Finally, many residents report noncompliance and duty hour falsification. The study was published in the May 1, 2013, issue of JAMA Surgery.

“The proposed benefits of the increased duty-hour restrictions—improved education, patient care, and quality of life—have ostensibly not borne out in surgical training,” concluded lead author Brian Drolet, MD, and colleagues. “It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.”

The 2011 ACGME duty hour rules include increased supervision, decreased work hours (especially for first year residents), and increased emphasis on the safe transfer of patient care during sign out. Main points include a maximum 80 hours’ work week averaged over a 4-week period, inclusive of in-house night calls, and a maximum of 24 consecutive hours inclusive of morning and noon educational programs. Rotations in which the trainee is assigned to emergency department (ED) duty shall ensure that they work no longer than 12 hour shifts.

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