Before and after resident work hour limitations: An objective assessment of the well-being of surgical residents

Stamp, Thomas; Termuhlen, Paula M.; Miller, Sidney F.; Nolan, Dan; Hutzel, P.; Gilchrist, J. A.; Johnson, R Michael

doi:10.1016/j.cursur.2004.09.013

Cited by 59 publications

(47 citation statements)

References 7 publications

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“…94 However, other aspects of well-being such as rates of depression do not seem to have changed between the pre-2003 period and the post-2003 period. 21,22,36,95 Prior research has demonstrated links between resident well-being and quality of patient care, 96,97 making preservation of resident well-being extremely important. This improvement in well-being may be one explanation for why some patient care parameters are improving in the post-2003 time period.…”

Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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“…To date, studies have not found a clear association between work hours and reports of depression (Goitein et al, 2005;Gopal et al, 2005;Stamp et al, 2005). In addition, four of the five studies addressing this did not find an association between depression and logged number of hours worked (Fahrenkopf et al, 2008;Katz et al, 2006;Sen et al, 2010;Valko et al, 1975).…”

Section: Amount Of Callmentioning

confidence: 99%

Depression in Resident Physicians: A Systematic Review

Joules¹,

Williams²,

Thompson³

2014

OJD

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Objective: To complete a systematic review of the literature addressing major depression in resident physicians. Methods: In 2013, the authors completed a systematic review of articles addressing major depression in physicians in United States residency programs. The following keywords were used: anxiety, stress, and mood, medical residents or interns, physician residents, graduate medical education, depression, stress or anxiety, and suicide. Results: The prevalence of depression in resident physicians is higher than that of the general population. Many sociodemographic and residency-associated factors have been studied in their relation to resident physician depression. Only physical health, an unhappy childhood, and stress at work were found to have association with depression, while the amount of call, lifestyle, age, income, and season of the year were not associated with depression. Other factors had an equivocal relationship. Depression in resident physicians is associated with medical errors, decreased ability to handle work-related stress, leaves of absence, discontinuation of medical training, disruption in personal lives, and suicide. Intervention with treatment for depression, using a low-cost, confidential, off-campus program, was successful. However, physicians may hesitate to seek treatment for mental illness because of the professional consequences, such as difficulty with medical licensing, hospital privileges, and malpractice insurance. Conclusions: Major depression is common in resident physicians in the United States. It has a negative impact on the lives of the doctors and the patients whom they treat. There appear to be effective ways of assisting residents with major depression available to training programs. Keywords

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“…Some research [3][4][5] after the duty hour reform showed that residents felt more rested or slept more hours. Studies reported reduced burnout in internal medicine residents 6,7 and decreased burnout 5 and improved quality of life among surgical trainees after the 2003 duty hour reform.…”

Section: Introductionmentioning

confidence: 99%

Impact of Protected Sleep Period for Internal Medicine Interns on Overnight Call on Depression, Burnout, and Empathy

Shea¹,

Bellini²,

Dinges³

et al. 2014

Journal of Graduate Medical Education

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Before and after resident work hour limitations: An objective assessment of the well-being of surgical residents

Cited by 59 publications

References 7 publications

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Depression in Resident Physicians: A Systematic Review

Impact of Protected Sleep Period for Internal Medicine Interns on Overnight Call on Depression, Burnout, and Empathy

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