A survey of residents and faculty regarding work hour limitations in surgical training programs

Mark J Niederee, Jason L Knudtson, Matthew C Byrnes, Stephen D Helmer, R Stephen Smith
Archives of Surgery 2003, 138 (6): 663-9; discussion 669-71

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions.

SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME).

PARTICIPANTS: All voluntarily participating surgical faculty and residents.

MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment.

METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis.

RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery.

CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.

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