Three-Year Results of Mandated Work Hour Restrictions: Attending and Resident Perspectives and Effects in a Community Hospital

Abstract

In response to the Accreditation Council of Graduate Medical Education mandated resident work hour restrictions, our residency program used a night float system in 2003. We undertook a survey of attending staff and residents to assess its effects on patient care and resident education. An anonymous survey was administered to attending staff and residents 1 year and 3 years after work hour restrictions took effect. The areas of disagreement include: beneficial effect on education (residents vs faculty: in 2004, 87% vs 22%, respectively, P = 0.02; in 2006, 71% vs 22%, P = 0.03); beneficial effect on patient care (in 2004, 53% vs 10%, P = 0.03); and compromised continuity of care (in 2004, 27% vs 70%, P = 0.04; in 2006, 7% vs 89%, P = 0.0002). One area of agreement was that residents’ quality of life had improved. Both disagreed that more errors were being made and that work hour restrictions should be mandated on practicing surgeons. Attending staff and residents have deeply held opinions regarding the effects of work hour restrictions. This reflects a continuing dissatisfaction with providing patient care and educating residents under a set of requirements that solely addresses resident sleepiness and fatigue.

A qualitative assessment of internal medicine resident perceptions of graduate medical education following implementation of the 2011 ACGME duty hour standards

“…Our findings validate published faculty concerns following the ACGME’s announcement of work hour limitations for residents and echo the few studies reporting on changes in graduate medical education outcomes following implementation of the 2003 ACGME duty hour standards [ 3 , 14 , 16 , 18 , 19 ]. More recently, a study assessing perceptions and attitudes of surgical residents via electronic survey found that 75% of responding residents expressed dissatisfaction with the 2011 duty hour standards and a large majority (75% of PGY-1 and 94% of PGY-2 through PGY-5) expressed concerns about the adverse impact of the work hour restrictions on the education of interns [ 20 ].…”

Effects of the reduction of surgical residents’ work hours and implications for surgical residency programs: a narrative review

“…Of our final sample of 24 studies, 10 assessed residents’ operating room experience before and after the implementation of work hours restrictions [ 4 - 13 ], 5 evaluated patient care [ 14 - 18 ], 3 examined professionalism [ 19 - 21 ], 2 assessed the opinions of attending physicians [ 4 , 22 ], 2 assessed compliance with work hours [ 21 , 23 ], one examined residents’ attrition rates [ 24 ], 3 examined residents’ opinions [ 10 , 25 , 26 ], one examined the financial demands of the work hours restrictions [ 10 ], and one examined exam scores [ 8 ]. The additional file 1 summarizes the study findings.…”

Night Float Teaching and Learning: Perceptions of Residents and Faculty

“…Reported advantages of night float include less resident stress and fatigue and enhanced alertness 5,6 as well as perceptions of improved patient care and fewer errors. 7 Other studies have focused on potential disadvantages such as service versus education, 8,9 discontinuous patient care, 10 nurse and patient satisfaction, 11 and the nuances of patient sign-outs. 12 The perceptions of night float are inconsistent in these reports; some aspects are viewed positively and others are viewed as neutral or negative.…”