Psychologic well-being of surgery residents after inception of the 80-hour workweek: A multi-institutional study

Zaré, S. Mahmood; Galanko, Joseph A.; Behrns, Kevin E.; Sieff, Elaine M.; Boyle, Lisa M.; Farley, David R.; Evans, Stephen; Meyer, Anthony A.; Farrell, Timothy M.

doi:10.1016/j.surg.2005.05.011

Cited by 35 publications

(22 citation statements)

References 27 publications

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“…Nine studies were of surgical (or surgical subspecialty) in-training examination scores, 49,50,52,54,61,64,69,70,73 and one examined the obstetrics and gynecology in-training examination. 35 These were mostly small single site studies with sample sizes ranging from 28 to 238.…”

Section: Standardized Testsmentioning

confidence: 99%

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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: Standardized Testsmentioning

confidence: 99%

“…35,52,54,69,73 Two studies demonstrated a decrease in examination scores between the pre-and post-duty hour periods. 50,70 Operative Experience…”

Section: Standardized Testsmentioning

confidence: 99%

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

2011

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“…There have been a large number of studies examining the effect of this change on resident ABSITE performance, with mixed results. 10,[37][38][39][40][41][42][43][44] It is possible that the introduction of work-hour restrictions may have been a confounding factor in some of the studies included in our review. The improvement seen in performance might be merely the result of more time available and individuals used to prepare for ABSITE rather than the effect of the interventions studied.…”

Section: Discussionmentioning

confidence: 99%

Interventions That Affect Resident Performance on the American Board of Surgery In-Training Examination: A Systematic Review

Kim

Tan

2015

Journal of Surgical Education

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“…6,[14][15][16][17]19,20 Improving the quality of residents' lives in and of itself may improve patient care and may change how certain residencies are viewed. Following implementation of the duty hours, general surgery residents reported feeling more enthusiastic about their jobs; this is an exciting change for a specialty that is often avoided because of its lifestyle.…”

Section: Resident Educationmentioning

confidence: 99%

Resident Work Hour Restrictions: Balancing Resident Education and Patient Safety

MacMullin

2013

DMJ

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Psychologic well-being of surgery residents after inception of the 80-hour workweek: A multi-institutional study

Cited by 35 publications

References 27 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

Interventions That Affect Resident Performance on the American Board of Surgery In-Training Examination: A Systematic Review

Resident Work Hour Restrictions: Balancing Resident Education and Patient Safety

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