Effects of Work Hour Reduction on Residents’ Lives

Fletcher, Kathlyn E.; Underwood, Willie; Davis, Steven Q.; Mangrulkar, Rajesh S.; McMahon, Laurence F.; Saint, Sanjay

doi:10.1001/jama.294.9.1088

Cited by 274 publications

(215 citation statements)

References 69 publications

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“…These alterations run the risk of decreasing clinical and procedural experience while potentially improving professional communication 3. There have been arguments for and against these changes, some believing that the number of procedures or experiences would increase and some arguing that they would decrease 31. Instituting mentoring programs, dedicated research, and/or dedicated teaching times have been found to improve resident satisfaction 3, 32.…”

Section: Discussionmentioning

confidence: 99%

A study of otolaryngology resident quality of life and sleepiness

Garcia‐Rodriguez

Sanchez

et al. 2017

Laryngoscope Investig Oto

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ObjectivesThis study aimed to determine otolaryngology residents' quality of life and sleepiness.MethodsAn electronic survey was distributed to otolaryngology residents in the United States in October 2014 and May 2015. The survey included questions from the Physician Well‐Being Index (PWBI) and Epworth Sleepiness Scale (ESS). Data were analyzed using standard descriptive and frequency analyses, Spearman correlations, and Student's t‐test.ResultsThe 196 respondents (13% response rate) had a mean age of 29.9 years and worked an average of 70.88 hours/week. Higher PWBI score (lower quality of life) correlated with higher ESS (more sleepiness) for all respondents regardless of rotation (Spearman coefficient of .45; p = .001). PWBI scores were higher for head/neck oncology. Both PWBI and ESS scores were highest for postgraduate year two. PWBI showed a significant positive correlation with hours worked (correlation coefficient .35; p = .001) as well as a significant negative correlation with exercise time (correlation coefficient ‐.18; p = .010). There was a positive correlation between hours worked and ESS (correlation coefficient .48; p = .001).ConclusionFor the otolaryngology survey respondents, sleepiness and overall well‐being were better during the first year with a dramatic worsening during junior years followed by an improvement in the senior years. More work hours and poor quality of life was associated with less physically active residents. Focused interventions during these rotations may reduce distress, improve quality of life, and enhance learning.Level of EvidenceNA

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Section: Discussionmentioning

confidence: 99%

A study of otolaryngology resident quality of life and sleepiness

Garcia‐Rodriguez

Sanchez

et al. 2017

Laryngoscope Investig Oto

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“…9 We focused on burnout in this review, but other studies have corroborated the improvement in well-being by documenting more residents having babies in the post-2003 time period, 93 greater ability to attend family events, 38 and less perceived stress. 94 However, other aspects of well-being such as rates of depression do not seem to have changed between the pre-2003 period and the post-2003 period.…”

Section: Discussionmentioning

confidence: 99%

“…This allows conclusions to be drawn that were not possible when the last comprehensive reviews on this subject were published. 8,9 Limitations notwithstanding, this review provides a comprehensive synthesis of the evidence base for the 2003 duty hour reforms in the US. The balance of evidence suggests that burnout among residents has decreased.…”

Section: Discussionmentioning

confidence: 99%

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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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“…[7][8][9][10][11] Training programs began to institute necessary changes but in doing so, created greater patient discontinuity and increased handoffs between residents, elevating the potential for adverse patient outcomes. 12 Recent largescale studies indicate that inpatient care is the same or improved since adoption of the duty hour restrictions, [13][14][15][16] but controversy continues, with several editorials debating the issue.…”

Section: Resident Duty Hour Restrictionsmentioning

confidence: 99%

Non–housestaff medicine services in academic centers: Models and challenges

Sehgal

Shah

Parekh

et al. 2008

Journal of Hospital Medicine

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Non-housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe nonhousestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the ''academic hospitalist''), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission.

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Effects of Work Hour Reduction on Residents’ Lives

Cited by 274 publications

References 69 publications

A study of otolaryngology resident quality of life and sleepiness

A study of otolaryngology resident quality of life and sleepiness

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

Non–housestaff medicine services in academic centers: Models and challenges

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