The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program

Abstract

Internal medicine residents approve of WHLs overall and report benefits to their well-being. However, they also report negative effects on patient care and resident education.

Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review

“…In this systematic review and meta-analysis of 19 studies enrolling 2030 residents, we found that 1 intervention, limiting resident hours, was consistently associated with a decreased emotional exhaustion component of burnout [12][13][14]21 and lower overall burnout rates. 15 Other interventions were examined in a few studies that enrolled small numbers of residents.…”

“…15,16 Several studies reported on more than 1 dimension of the MBI. Improvement in emotional exhaustion was reported in 4 studies, [12][13][14]21 improvement in depersonalization was reported in 1 study, 19 and improvements in personal achievement was reported in 1 study. 10 Only 1 of the 2 studies reported the overall burnout score and significant improvement, although the direction of the effect was the same in both studies.…”

“…9 We pooled data from the 9 studies that examined the effect of work hour limits on burnout rates using random effects meta-analysis that accounted for between-study heterogeneity. 7,[10][11][12][13][14][15][16][17] The studies reported data in different forms; when studies reported data on the number (or percentage) of residents with high levels of burnout, we pooled their odds ratios (ORs), and when studies reported mean burnout scores, we pooled their mean differences. Six of the 9 studies reported data on all or some components of the Maslach Burnout Inventory (MBI; Mind Garden, Menlo Park, CA), and data were pooled within those components.…”

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

“…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.…”

“…Rates of burnout did not statistically significantly worsen in any study, although there was a nonsignificant worsening in one study. 21 Burnout improved in five studies, 22,30,36,51,54 most often as a result of a decrease in emotional exhaustion. Two studies found that a higher number of work hours was related to burnout.…”