National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training

Exploring Qualitative Perspectives on Surgical Resident Training, Well-Being, and Patient Care

“…In addition, flexible policy residents were more likely to perceive negative effects of duty hour policies on resident outcomes that depended on time away from the hospital. 12 These contradictory findings suggest that there is more to be learned about perceptions of duty hour regulations and highlight the need for additional qualitative research to complement the quantitative findings. We designed and pilot tested a qualitative research study to examine how PDs, residents, and attending surgeons perceived resident duty hour regulations to affect resident education, personal well-being, and perceived patient safety after 2011 and during the FIRST Trial, and understand what changes to duty hour policy they would recommend to best meet the needs of patients and residents.…”

“…1,[9][10][11] In addition, it has been argued that these restrictions had the unintended consequence of negatively affecting resident education and interrupting continuity of patient care. 1,7,[12][13][14][15][16][17][18][19] Past studies measuring the effects of duty hours on patient outcomes, resident well-being, and education have been inconclusive or have shown no increased benefit to restricting duty hours. 13,18,[20][21][22][23][24][25] To study the effects of duty hour policies on patient and resident outcomes, the FIRST trial was implemented in July 2014.…”

“…3 The FIRST trial authors concluded that flexible duty hour policies for surgical residents were noninferior to current ACGME duty hour policies for patient outcomes and resulted in similar resident satisfaction about their overall well-being and education quality. 12 Research to gauge resident and program director (PD) perceptions of duty hour requirements suggests that the 2011 restrictions drove resident dissatisfaction and delayed maturation of residents, brought about challenges surrounding the night float system, and decreased the surgical case volume for residents. [26][27][28] Similarly, secondary resident outcomes from the FIRST trial showed that residents in the flexible policy arm were more likely to be dissatisfied with the time for rest.…”

“…13,18,[20][21][22][23][24][25] To study the effects of duty hour policies on patient and resident outcomes, the FIRST trial was implemented in July 2014. 12,22 This 2-arm trial randomized general surgery residency programs to an intervention arm that waived the 2011 rules on maximum shift lengths and time off between shifts (flexible policy), maintaining the maximum 80-hour per week rule; or to a control arm with current 2011 ACGME duty hour policies (standard policy). The methods have been described extensively elsewhere.…”

Thinking clearly about the FIRST trial: addressing ethical challenges in cluster randomised trials of policy interventions involving health providers

“…How can evidence guide the development of policy for medical education? The Flexibility In duty hour Requirements for Surgical Trainees (FIRST) was a pragmatic, non-inferiority, cluster randomised trial (CRT) involving surgical residency programmes in USA 1. It evaluated flexible duty-hour policies allowing longer shifts, compared with standard restricted duty-hour policies, with respect to patient safety and resident well-being.…”