Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology

Abstract

Background Prior studies of resident experience in gynecology looked only at the year before and after adoption of ACGME duty hour standards. This study sought to determine whether procedure volume differed after completion of a 4-year residency training program, before and after work hour reform. Method Inpatient and outpatient procedures performed by MetroHealth Medical Center/Cleveland Clinic program residents from 1998 to 2006 were obtained from Annual Reports of Institutional and Resident Experience. Four-year experience before and after duty hour restrictions were compared: hours worked were collected from resident schedules, ambulatory hours and procedures were compared directly, surgical procedures and deliveries were compared using a 2-tailed t test. Data were also obtained for institutional volume changes, and a corrected value, based on the rates of resident cases per available cases, was analyzed. Results Ambulatory hours worked per resident decreased after implementing work hour reform from 674 to 366 hours. The types of ambulatory and surgical procedures performed varied over time. Overall, basic surgical and obstetrical volume per resident did not change before and after work hour reform (mean before reform, 723 ± 117, mean after reform, 781 ± 200, P = .58 for gynecologic procedures; mean before reform, 611 ± 107, mean after reform, 535 ± 73, P = .18 for basic obstetrics and vaginal and cesarean deliveries). Institutional volume did not change significantly, although the percentage of the institutions' cases performed by residents did decrease for some procedures. Conclusion The ACGME duty hour restrictions do not limit the overall ambulatory or surgical procedural volume in an obstetrics and gynecology residency-training period.

Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

“…4,6 Similarly, our data show no change in the total number of cesarean deliveries performed by graduating residents. However, there was a significant decrease in the number of total abdominal hysterectomies and a simultaneous increase in the total number of major laparoscopic procedures performed by graduating residents during the study period.…”

“…[1][2][3][4][5][6] While the debate over adequate surgical exposure continues, few studies have evaluated the association of duty hour restrictions on resident surgical performance and proficiency. The purpose of our study was to assess the association between duty hour restrictions and the time to perform an uncomplicated cesarean delivery.…”

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

“…A confounding factor is the concurrent development of orthopedic trauma cases transitioning to being performed in a dedicated trauma operating room during the data instead of as add-on cases after elective cases. In comparison, other surgical specialties have seen decreases in surgical caseload volume [15] but no change in obstetric and gynecology [16]. Further study correlating case volume and patient outcomes and safety would be beneficial and would support residency duty-hour changes.…”

National Trends in Carpal Tunnel Release and Hand Fracture Procedures Performed During Orthopaedic Residency: An Analysis of ACGME Case Logs

“…This study is of interest because procedural case volume is a topic of importance for resident education in several specialties. [7][8][9] Additionally, the methodology of our study may serve as a blueprint for assessments of resident caseload in other surgical specialties.…”