Effect of the ACGME Duty Hours Restrictions on Surgical Residents and Faculty: A Systematic Review

Jamal, Mohammad H.; Rousseau, Mathieu; Hanna, Waël C.; Doi, Suhail A.R.; Meterissian, Sarkis; Snell, Linda

doi:10.1097/acm.0b013e3181ffb264

Cited by 105 publications

(94 citation statements)

References 58 publications

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“…In a review of the frameworks used to conceptualize this discussion, Schwartz et al point out that it is imperative to work from models that take into account the trade-offs associated with public policy issues such as this one. 84 A recent review by Jamal and colleagues focused on the effects of duty hour limits on surgeons 85 , and a second review by Reed et al examined evidence specifically pertaining to shift length and night float 86 . Our review differs from and expands upon these prior reviews by providing a comprehensive synthesis of the impact of the 2003 duty hour policy reforms on the most important stakeholder groups: patients and residents of all specialties.…”

Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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“…[1][2][3][4][5][6] While the debate over adequate surgical exposure continues, few studies have evaluated the association of duty hour restrictions on resident surgical performance and proficiency. The purpose of our study was to assess the association between duty hour restrictions and the time to perform an uncomplicated cesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

Smrtka

Gunatilake

Harris

et al. 2015

Journal of Graduate Medical Education

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Canada does not have uniform, panCanadian legislation governing aspects of the working environment for residents. In most provinces, there is a limit of 24 hours for a single call shift.…”

Section: Introductionmentioning

confidence: 99%

Urology residents on call: Investigating the workload and relevance of calls

Thériault

Marceau-Grimard²,

Blais

et al. 2017

CUAJ

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Introduction: On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really is. As part of an effort to ameliorate our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls. Method: We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre-and post-collecting period questionnaires. Results: A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean (median, range) of 3.5 (3, 0-12) calls per weeknight and 7.7 (6, 0-23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultation (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls. Conclusions: Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.

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Effect of the ACGME Duty Hours Restrictions on Surgical Residents and Faculty: A Systematic Review

Cited by 105 publications

References 58 publications

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

Urology residents on call: Investigating the workload and relevance of calls

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