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

Abstract

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.

Teaching and proficiency assessment for arthroscopy in veterinary surgery: A 2017 survey of diplomates and residents of the American and European College of Veterinary Surgeons

“…However, the majority of those surveyed reported that they are in favor of more formal proficiency assessment. Several assessment scales have been developed for proficiency assessment on clinical cases, cadavers, and simulators in human surgery; however, no assessment scale has been proved superior to any other . A validated veterinary surgery assessment scale has not yet been developed for arthroscopic skills assessment.…”

“…Several assessment scales have been developed for proficiency assessment on clinical cases, cadavers, and simulators in human surgery; however, no assessment scale has been proved superior to any other. 44,45 A validated veterinary surgery assessment scale has not yet been developed for arthroscopic skills assessment. Development and use of an adapted assessment scale for simulation training and for clinical cases would permit standardization of program evaluation.…”

Urology Residents’ Perspectives on the In-House On-Call Systems: A Study in an Accredited Academic Center

“…Compliance with ACGME-I working hours rules 14 had positive effects on the residents’ lifestyle, satisfaction level with clinical learning, and education without any adverse effects on their operative experience. 28 – 31 . Adherence to the ACGME-I rules among HMC residents has previously been associated with improved examination and research performance.…”

A narrative review of the impact of work hours and insufficient rest on job performance

“…7,[62][63][64] Changing these regulations may be impeded by cultural norms and concerns about discontinuity of care, apprehension of the possibility of reduced case exposure affecting resident training, fiscal concerns, and insufficient evidence of reductions in medical error rates or resident stress in some studies. 3,40,[65][66][67][68] Long working hours during clinical training programs have traditionally been considered inevitable to ensure competency and instill professionalism. Surgeons have voiced concerns about possible compromise in the quality of resident training and operative experience if working hours are limited during the set number of years assigned to the program.…”

“…Too often, hospital systems rely on fatigued clinicians and trainees to cover services without assessing potential impairment. [2][3][4] While this topic is poorly discussed in veterinary-specific literature, veterinary surgeons should understand how fatigue affects their capabilities and patient safety. The objective of this review is to summarize the evidence documenting the impact of occupational sleep insufficiency on functions relevant to veterinary surgeons such as work performance, patient safety, and team dynamics.…”