Differences in Resident Perceptions by Postgraduate Year of Duty Hour Policies: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial

Yang, Anthony D.; Chung, Jeanette W.; Dahlke, Allison R.; Biester, Thomas W.; Quinn, Christopher; Matulewicz, Richard S.; Odell, David D.; Kelz, Rachel R.; Shea, Judy A.; Lewis, Frank R.; Bilimoria, Karl Y.

doi:10.1016/j.jamcollsurg.2016.10.045

Cited by 36 publications

(40 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…That our finding is of greater magnitude may reflect the comparison of junior residents to those at considerably more advanced stages of training. The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, a prospective, randomized trial assessing impact of duty hour flexibility for general surgical trainees, also demonstrated increased concerns among senior residents, compared with junior residents, about negative effects of standard DHRs on patient safety and continuity of care [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center

et al. 2017

View full text Add to dashboard Cite

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) implemented revisions to resident duty hour requirements (DHRs) in 2011 to improve patient safety and resident well-being. Perceptions of DHRs have been reported to vary by training stage and specialty among internal medicine and general surgery residents. The authors explored perceptions of DHRs among all residents at a large academic medical center.MethodsThe authors administered an anonymous cross-sectional survey about DHRs to residents enrolled in all ACGME-accredited core residency programs at their institution. Residents were categorized as medical and pediatric, surgery, or other.ResultsIn total, 736 residents representing 24 core specialty residency programs were surveyed. The authors received responses from 495 residents (67%). A majority reported satisfaction (78%) with DHRs and believed DHRs positively affect their training (73%). Residents in surgical specialties and in advanced stages of training were significantly less likely to view DHRs favorably. Most respondents believed fatigue contributes to errors (89%) and DHRs reduce both fatigue (80%) and performance of clinical duties while fatigued (74%). A minority of respondents (37%) believed that DHRs decrease medical errors. This finding may reflect beliefs that handovers contribute more to errors than fatigue (41%). Negative perceived effects included diminished patient familiarity and continuity of care (62%) and diminished clinical educational experiences for residents (41%).ConclusionsA majority of residents reported satisfaction with the 2011 DHRs, although satisfaction was significantly less among residents in surgical specialties and those in advanced stages of training.

show abstract

Section: Discussionmentioning

confidence: 99%

“…A subsequent systematic review associated the 16-h duty maximums with a nonsignificant trend toward worsened educational outcomes [ 21 ]. Similarly, the FIRST trial showed no significant difference between standard and flexible duty hour groups with regard to overall educational quality [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center

et al. 2017

View full text Add to dashboard Cite

show abstract

“…These gains came at a cost: interns in flexible duty-hour programs were more likely to report perceiving negative effects on their personal activities outside of work than their peers from standard duty-hour programs [ 23 ]. Nonetheless, surgical residents reported a preference for flexible policies with increasing frequency as they progressed temporally through their training programs, as well as a sentiment that rigid duty-hour policies were negatively affecting critical outcomes like patient safety, morale, and continuity of care [ 24 ].…”

Section: Divides Between Medicine and Surgerymentioning

confidence: 99%

“…There are many possible explanations for the discordance. One postulate for consideration is that medical graduates who self-select to surgical residencies are inclined toward personality traits that diverge from those that are predominant in medical graduates who are attracted to medical programs, and that the surgical training system (which contains abundant rewards only internal to itself, such that external motivators become undervalued) exacerbates these differences [ 24 ]. Alternatively (or additionally), a second possible explanation is that in Surgery—more than in Medicine—there is no reliable replacement for case volume as a means toward achieving proficiency, a finding that trainees increasingly appreciate as they proceed further along their training.…”

Section: A Fundamental Difference In Valuesmentioning

confidence: 99%

Divides of identity in medicine and surgery: A review of duty-hour policy preference

Brenna

Das

2020

Annals of Medicine and Surgery

View full text Add to dashboard Cite

Surgery and Medicine are broadly considered as the two fundamental paths that a physician's career can follow. But their convergence under the singular umbrella of doctoring is relatively recent in the context of medical history. Their co-existence within the structure of medical education and the healthcare system suggest that they bear great similarity to each other, when in reality several differences are intuitively recognizable between them. Here, we discuss recent evidence suggesting a discrepancy between these two streams in the work-hour policy preference of trainees. We argue that these differences betray a more radical divide between them, and one which illuminates an essential difference in the self-identification of surgical and non-surgical medical trainees. Additionally, these findings support a novel claim about the importance of uninterrupted relationships on the formation of professional identity among healthcare professionals. We suggest that the principal separation of surgical and non-surgical practice is significant enough to reconsider their dogmatic unification as well as warrant the adoption of unique rules and policies to govern each stream.

show abstract

“…Specific regulations have particularly powerful effects on surgical trainees, with 12 of 14 (86%) studies showing that a 16‐hour duty maximum had a negative effect on resident training and 5 of 6 studies showing decreased operating room time in 1 systematic review . Negative impressions toward duty hours restrictions are related to program year of the trainee and tend to increase over time, with the majority of senior residents in surgical training programs favoring a more flexible approach to duty hours …”

Section: Goals Of Reformmentioning

confidence: 99%

Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

2018

View full text Add to dashboard Cite

To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors. Effects on resident training are program specific, with duty hours restrictions having the most deleterious effects on surgical disciplines. Because veterinary specialists assume a similar role in providing 24-hour patient care, interns and residents face work-related stress as a result of extended working hours, on-call duty, and an increasingly complex caseload. The North Carolina State Veterinary Hospital is staffed by approximately 100 house officers representing almost every veterinary specialty group. We surveyed departing house officers regarding their quality of life and training experience. Sixty-six percent of interns and residents reported that they do not have time to take care of personal needs, and 57%-62% felt neutral or dissatisfied with their mental and physical well-being. Most trainees believed that decreased duty hours would improve learning, but 42% believed that decreased caseload would be detrimental to training. Veterinary educators must consider post-DVM veterinary training guidelines that maintain patient care with a good learning environment for interns and residents.

show abstract

Differences in Resident Perceptions by Postgraduate Year of Duty Hour Policies: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial

Cited by 36 publications

References 8 publications

Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center

Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center

Divides of identity in medicine and surgery: A review of duty-hour policy preference

Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

Contact Info

Product

Resources

About