Effect of Work-hour Reforms on Operative Case Volume of Surgical Residents

Ferguson, Charles M.; Kellogg, Katherine C.; Hutter, Matthew M.; Warshaw, Andrew L.

doi:10.1016/j.cursur.2005.04.001

Cited by 107 publications

(51 citation statements)

References 7 publications

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“…The type of operative experience varied between studies. Of the 17 studies that evaluated the relationship between duty hour rules and overall surgical experience or overall experience as the main surgeon, two showed significant decreases, one showed a significant increase, nine showed no change, 40,52,54,55,59,64,71,73,81 and several others did not report statistical analyses. Many of these studies were single site studies, and likely underpowered to detect a true difference.…”

Section: Standardized Testsmentioning

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: Standardized Testsmentioning

confidence: 99%

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

2011

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“…[5][6][7][8] Prior studies have evaluated surgical and procedural volume in obstetrics and gynecology and in general surgery, both before and after the work hour restrictions. 5,6,9 These studies however, were not longitudinal and did not evaluate experience over a complete residency training period. In addition, there is concern that ambulatory experience may be compromised in efforts to provide adequate resident experience in other areas.…”

Section: Introductionmentioning

confidence: 99%

Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology

Kane¹,

Siddiqui²,

Bailit³

et al. 2010

Journal of Graduate Medical Education

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Background Prior studies of resident experience in gynecology looked only at the year before and after adoption of ACGME duty hour standards. This study sought to determine whether procedure volume differed after completion of a 4-year residency training program, before and after work hour reform. Method Inpatient and outpatient procedures performed by MetroHealth Medical Center/Cleveland Clinic program residents from 1998 to 2006 were obtained from Annual Reports of Institutional and Resident Experience. Four-year experience before and after duty hour restrictions were compared: hours worked were collected from resident schedules, ambulatory hours and procedures were compared directly, surgical procedures and deliveries were compared using a 2-tailed t test. Data were also obtained for institutional volume changes, and a corrected value, based on the rates of resident cases per available cases, was analyzed. Results Ambulatory hours worked per resident decreased after implementing work hour reform from 674 to 366 hours. The types of ambulatory and surgical procedures performed varied over time. Overall, basic surgical and obstetrical volume per resident did not change before and after work hour reform (mean before reform, 723 ± 117, mean after reform, 781 ± 200, P = .58 for gynecologic procedures; mean before reform, 611 ± 107, mean after reform, 535 ± 73, P = .18 for basic obstetrics and vaginal and cesarean deliveries). Institutional volume did not change significantly, although the percentage of the institutions' cases performed by residents did decrease for some procedures. Conclusion The ACGME duty hour restrictions do not limit the overall ambulatory or surgical procedural volume in an obstetrics and gynecology residency-training period.

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“…7 Although the effects of duty hour restriction on pediatric resident resuscitation experiences are not well described, in procedure-oriented specialties, resident duty hour limits have decreased trainee procedure volumes 18 unless significant alterations are made in training program structure. [19][20][21][22] With duty hour restrictions, many centers have relied on NNP's or physician's assistants to provide clinical coverage that previously would have been provided by residents. 7,23 The combination of duty hour limits and the utilization of non-trainee clinicians to provide delivery room coverage have decreased resident resuscitation experiences by 50% in one institution.…”

Section: Discussionmentioning

confidence: 99%

A delivery room-focused education and deliberate practice can improve pediatric resident resuscitation training

2012

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Effect of Work-hour Reforms on Operative Case Volume of Surgical Residents

Cited by 107 publications

References 7 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

Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology

A delivery room-focused education and deliberate practice can improve pediatric resident resuscitation training

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