Work-hour restrictions and orthopaedic resident education: a systematic review

Mauser, Nathan S.; Michelson, James D.; Gissel, Hannah; Henderson, Corey; Mauffrey, Cyril

doi:10.1007/s00264-015-3045-7

Cited by 18 publications

(12 citation statements)

References 22 publications

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“…2,[4][5][6] Similar perceptions were noted historically after the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions in 2011 were enacted, as residents reported decreased educational opportunities secondary to a decrease in hours worked, and faculty reported first-year attendings required more supervision after implementation of work hour restrictions. [7][8][9][10] This historical information endorses current concerns that work hour decreases secondary to pandemic-related changes to resident clinical schedule may negatively impact resident education. 7 To better understand whether educational quality was affected by COVID-19-related residency schedule changes, we must first determine if a decrease in work hours occurred.…”

Section: Introductionmentioning

confidence: 73%

“…As demonstrated with regulation of work hours, a decrease in clinical work hours can impact educational and clinical experiences. [7][8][9] Historically, regulated decreases in work hours were associated with the shifting of responsibilities to senior residents and concerns about graduating residents' competency. 7,10 Similar effects may be caused by this demonstrated decrease in work hours during the early pandemic.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution

Lund

Hinduja

Doherty

et al. 2022

Journal of Graduate Medical Education

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Background The COVID-19 pandemic affected graduate medical education (GME) by decreasing elective procedures and disrupting didactic learning activities in 2020. Editorials have hypothesized that resident physicians worked fewer hours, therefore losing valuable experience, but we are not aware of studies that have objectively assessed changes in hours worked. Objective This study aims to identify differences secondary to the COVID-19 pandemic in resident work hours across all specialties at 3 geographically dispersed, integrated academic hospitals in a large sponsoring institution. Methods We obtained de-identified work hour data from all residency programs at Mayo Clinic in Arizona, Florida, and Minnesota. Resident work hours were compared between 2020 and 2019 from March to May. Results Work hours for 1149 and 1118 residents during the pandemic and control periods respectively were compared. Decreases in resident work hours were seen, with the largest decrease demonstrated in April 2020 when 19 of 43 programs demonstrated significantly decreased work hours. Residents worked more hours from home in April 2020 compared to the previous year (Arizona: mean 1 hour in 2019 vs 5.2 hours in 2020, P<.001; Florida: mean 0.7 hour in 2019 vs 6.5 hours in 2020, P<.001; Minnesota: mean 0.8 hour in 2019 vs 10.2 hours in 2020, P<.001). Conclusions The COVID-19 pandemic was associated with a decrease in work hours in some, but not all, specialties. The decrease in on-site work was only partially offset by an increased number of hours worked from home.

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Section: Introductionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution

Lund

Hinduja

Doherty

et al. 2022

Journal of Graduate Medical Education

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“…Differences in attitudes towards duty hour restrictions between junior and senior level residents has been well documented. 9 It follows there may be differential perceptions towards tracking methods. Traditionally, junior residents are younger and likely to be more apt with smartphone use.…”

Section: Discussionmentioning

confidence: 99%

Duty Hours Tracking – Is There an App for That?

Jorgensen

Savage

Sun

et al. 2022

Journal of Medical Education and Curricular Development

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BACKGROUND To monitor duty hour compliance residency programs have used self-report methods which can be skewed by recall bias and data falsification. The purpose of this study was to compare the accuracy of and resident attitudes towards two duty hours tracking tools within our Orthopedic residency. We compared our institution's current self-report method of duty hours tracking via New Innovations (NI) with an automated method utilizing Hours Tracker (HT), a smartphone application which automatically logs work hours via GPS coordinates. The primary outcome measures were number of duty hour violations and survey results on resident perceptions. METHODS The participants were 22 residents of our 25 resident Orthopedic program. Over four weeks, residents tracked duty hours through the standard, selfreport method (NI) and simultaneously through the automated app (HT). Residents also completed an anonymous survey at the end of the study related to perceptions of the methods. RESULTS There was no significant difference in overall number of violations between NI and HT. HT detected more violations of the 8 hours off requirement (12 vs. 5, p = 0.03). Survey data revealed residents found HT significantly easier to use (p = .004) and less burdensome (p < .001) but in greater violation of privacy (p = .001). Residents reported they were more likely to falsify their hours when using NI (p = .002) and that the results of NI would be more likely used against them (p = .042). When analyzing by training year, junior residents indicated HT was overall easier to use than senior residents (p = .048). CONCLUSIONS Our study showed NI and HT are at least equivalent in accuracy with the app being overall better received, particularly by junior level residents. Until we begin accurately tracking duty hours and engaging residents with an easy to use, well-received interface to which report hours, effective developmental program changes will be difficult to achieve. An app-based approach is a starting point for re-thinking duty hours tracking within this digital age.

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“…Since the initiation of work-hour re-strictions on July 1, 2003, residents are forced to assimilate the same mass of knowledge. [11][12][13] They must do so in an expeditious fashion in a changing academic setting, given that surgical volume is unchanged for junior residents and increased for senior residents after hour regulations. 14 Higher educational learning is changing with evolving technology and instant access to unlimited resources, as well as a large volume of yearly publications in the field.…”

Section: Discussionmentioning

confidence: 99%

Educational Resource Utilization by Current Orthopaedic Surgical Residents: A Nation-wide Survey

et al. 2019

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Background: More than 150 accredited orthopaedic residency programs exist in the United States with more than 3,300 residents. Every year, between 600 and 800 orthopaedic surgeons complete board certification. However, little is known about what residents use and prefer of the many resources available to them. The purpose of this study is to understand how orthopaedic residents across the country prioritize educational resources. Methods: An 18-question survey with subqueries was compiled on the REDCap (Research Electronic Data Capture) platform. Residents were reached through program coordinators, program directors, and word of mouth. There were 374 total respondents. Responses were summarized for the total population and stratified separately by sex, location, and year of training. P values were adjusted for multiple comparisons using the Bonferroni method. Results: Respondents were 83.4% male and 16.6% female. Orthobullets was the single most valued resource and general review articles were the single most valued journal resource. The average time spent studying was 10.7 hr/wk (SD = 7.6), with no notable differences by program location or sex. A significantly larger percentage of female residents placed more importance on specialty-specific journals (32.8% rated as very important versus 19.9% from males, P = 0.016) and research-related journals ( P = 0.004). VuMedi use significantly increased until postgraduate year-4 ( P < 0.001), whereas residents earlier in training used YouTube more often ( P = 0.026). There were differences in journal prioritization by program region, with the Midwest, Northeast, and South preferring primary, focused articles and the Northeast, South, and West emphasizing systematic review articles ( P = 0.032). Industry-sponsored events were used by 67.4% of residents as an educational adjunct. Conclusions: Current residents—regardless of sex, location, and year in training—use Orthobullets and other electronic resources. There continues to be utilization of industry-sponsored resources, although they are not the primary focus for those in training.

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Work-hour restrictions and orthopaedic resident education: a systematic review

Cited by 18 publications

References 22 publications

Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution

Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution

Duty Hours Tracking – Is There an App for That?

Educational Resource Utilization by Current Orthopaedic Surgical Residents: A Nation-wide Survey

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