Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation.

Abstract

In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

“…While costs would be much lower if interns maintain their current productivity under modified schedules, educational opportunities may decline because optimal schedules could differ between learning and service objectives. After 2003, operative experience fell for some surgical residents, and elective rotations and teaching conference attendance declined at some Internal Medicine programs 8,20 .…”

“…Next, we selected substitute providers. After 2003, programs shifted work among existing residents, hired midlevel providers (nurse practitioners and physician assistants), and gave attendings additional responsibilities; teaching hospitals hired more nurses 10,[17][18][19][20][21][22][23][24][25] . Few programs expanded, likely because the Balanced Budget Act caps Medicare-supported residency positions 26 .…”

“The Benefits Make Up for Whatever Is Lost”

“…Although there is a developing literature on the effects of DHRs, many related studies rely on self-administered survey data 3,8,9,11,14 or focus on only one group of stakeholders. [8][9][10][11] When training programs undergo significant modifications, performing initial open-ended exploratory analyses across different stakeholder groups may be more informative than collecting survey data from a single cohort.…”

“…These include potential liabilities to patient safety in other areas, such as increased sign-over and more cross-coverage, 6 and possible threats to resident education. 3,4,[7][8][9][10] In addition, some attendings believe that the new regulations are generating a new sort of physician, one that is less altruistic, less professional, and less dedicated to patients. 7,9,10 Many faculty are also dissatisfied with the amount of work they are now expected to carry out to accommodate resident understaffing as a result of the new regulations.…”

The Impact of the Internal Medicine Sub-internship on Medical Student Career Choice

“…Duty hour regulation has led to re-distributed rather than relinquished work and has been associated with less participation in educational conferences 25 . Sub-interns perceptions about work intensity, at the expense of education, also may contribute to workload perceptions.…”