Resident Operative Experience in General Surgery, Plastic Surgery, and Urology 5 Years After Implementation of the ACGME Duty Hour Policy

Simien, Christopher; Holt, Kathleen; Richter, Thomas; Whalen, Thomas V.; Coburn, Michael; Havlik, Robert J.; Miller, Rebecca S.

doi:10.1097/sla.0b013e3181e62299

Cited by 54 publications

(41 citation statements)

References 30 publications

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“…With the current ACGME regulations restricting residents to an 80-h work week [27,33,39,45], strong mentor-mentee Fig. 2 Themes discussed regarding barriers to mentorship relationships could play a crucial role in alleviating rising concerns regarding the decrease in "on-the-job" training time.…”

Section: Discussionmentioning

confidence: 99%

Mentorship in Surgical Training: A Systematic Review

Entezami

Franzblau

Chung

2011

Hand (New York, N,Y.)

142

102

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Objective This review systematically examines the literature regarding mentor-mentee relationships in surgery. Background The usefulness of mentorship in surgical training has been expressed in many articles. However, to date, there has been no systematic review on mentoring surgical trainees. This surgical environment is different from other areas of medicine and requires young surgeons to learn skills not readily available from textbooks. Instead, mentors are a valuable mode of transferring this knowledge to the next generation of surgeons. Thus, mentorship is a worthy area of research and attention. Methods We identified all articles discussing mentorship in surgery between January 1985 and August 2010 using PubMed and ISI Web of Knowledge. Predetermined exclusion and inclusion criteria were used to screen articles by title, abstract, and full text in sequence. We extracted the relevant data, and then analyzed the prevalence of major surgical mentoring themes in the literature. Results Of the 1,091 unique articles found during our original literature search, 38 were selected for review. The majority (68%) were commentary/editorial articles. The most discussed themes include the desirable qualities of a surgical mentor, the structure of mentor-mentee relationships, and advice for overcoming barriers to mentoring. Much less discussed themes include the desirable traits in a mentee and the appreciation of generational and cultural differences in mentorship.Conclusions Several barriers to effective surgical mentoring were identified, such as time constraints and a lack of female mentors. By focusing on the positive traits found in this review, for example, developing formal programs to alleviate time constraints, these barriers can be overcome and effective mentor-mentee relationships can be built. Many articles draw attention to the dying art of mentorship in surgical training programs, and currently, the literature on mentorship in surgery is somewhat scarce. These concerns should serve as motivation to revive mentorship in surgery education and to expand the literature regarding underexplored themes and overcoming the current barriers. Although mentorship may not always take on a structured form, it should not be treated casually because proper mentorship is the foundation for training quality surgeons.

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Section: Discussionmentioning

confidence: 99%

Mentorship in Surgical Training: A Systematic Review

Entezami

Franzblau

Chung

2011

Hand (New York, N,Y.)

142

102

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“…10 They concluded that duty-hour restrictions had a beneficial effect on resident burnout, mood, hours of sleep, and alertness, and found no effect on operative volume. 10,29 In contrast, patient safety, continuity of care, and educational continuity diminished, especially within surgical specialties. In 2013, multiple stakeholders from the Canadian graduate medical education system published a consensus report called Fatigue, Risk, and Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours, 27,28 which found suboptimal outcomes in surgical care delivery and surgical training when total or consecutive hours of resident duty are rigidly restricted.…”

Section: Educational Reform: Lessons From Duty-hour Restrictionsmentioning

confidence: 92%

“…24 Although these regulations have been widely accepted, the evidence to support duty-hour restrictions remains controversial. 10,11,13,[26][27][28][29][30][31] For example, a systematic review by Philibert et al looked at 83 studies that evaluated the influence of the Accreditation Council for Graduate Medical Education restrictions on outcomes related to resident training, lifestyle, and patient safety. 10 They concluded that duty-hour restrictions had a beneficial effect on resident burnout, mood, hours of sleep, and alertness, and found no effect on operative volume.…”

Section: Educational Reform: Lessons From Duty-hour Restrictionsmentioning

confidence: 99%

Evidence-Based Education in Plastic Surgery

Johnson

Chung

Waljee

2015

Plastic and Reconstructive Surgery

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Educational reforms in resident training have historically been driven by reports from medical societies and organizations. Although educational initiatives are well intended, they are rarely supported by robust evidence. The Accreditation Council for Graduate Medical Education recently introduced competency-based training, a form of outcomes-based education that has been used successfully in nonmedical professional vocations. This initiative has promise to advance the quality of resident education, but questions remain regarding implementation within plastic surgery. In particular, how will competency-based training impact patient outcomes, and will the methodologies used to assess competencies (i.e., milestones) be accurate and validated by literature? This report investigates resident educational reform and the need for more evidence-based educational initiatives in plastic surgery training.

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“…However, evidence for the latter is unclear, with residents in some surgical specialties experiencing increasing operative volume, while others experience decreased or unchanged volume. 30,31 Nonetheless, studies from various surgical specialties including cardiac, orthopedic, and neurological surgery have demonstrated worse outcomes in the duty-hour reform era. 7,11,15 The analysis of spinal procedures provides unique insights into the effects of duty-hour reform on residents' clinical and surgical abilities.…”

Section: Discussionmentioning

confidence: 99%

Morbidity, mortality, and health care costs for patients undergoing spine surgery following the ACGME resident duty-hour reform

Babu

Thomas

Hazzard

et al. 2014

SPI

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Object The Accreditation Council for Graduate Medical Education (ACGME) implemented resident duty-hour restrictions on July 1, 2003, in concern for patient and resident safety. Whereas studies have shown that duty-hour restrictions have increased resident quality of life, there have been mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay (LOS), and charges in patients who underwent spine surgery. Methods The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, LOS, and charges by comparing the prereform (2000–2002) and postreform (2005–2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. Results A total of 693,058 patients were included in the study. The overall complication rate was 8.6%, with patients in the postreform era having a significantly higher rate than those in the pre–duty-hour restriction era (8.7% vs 8.4%, p < 0.0001). Examination of hospital teaching status revealed complication rates to decrease in nonteaching hospitals (8.2% vs 7.6%, p < 0.0001) while increasing in teaching institutions (8.6% vs 9.6%, p < 0.0001) in the duty-hour reform era. The DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching institutions to had a significantly greater increase in complications during the postreform era (p = 0.0002). The overall mortality rate was 0.37%, with no significant difference between the pre– and post–duty-hour eras (0.39% vs 0.36%, p = 0.12). However, the mortality rate significantly decreased in nonteaching hospitals in the postreform era (0.30% vs 0.23%, p = 0.0008), while remaining the same in teaching institutions (0.46% vs 0.46%, p = 0.75). The DID analysis to compare the changes in mortality between groups revealed that the difference between the effects approached significance (p = 0.069). The mean LOS for all patients was 4.2 days, with hospital stay decreasing in nonteaching hospitals (3.7 vs 3.5 days, p < 0.0001) while significantly increasing in teaching institutions (4.7 vs 4.8 days, p < 0.0001). The DID analysis did not demonstrate the magnitude of change for each group to differ significantly (p = 0.26). Total patient charges were seen to rise significantly in the post–duty-hour reform era, increasing from $40,000 in the prereform era to $69,000 in the postreform era. The DID analysis did not reveal a significant difference between the changes in charges between teaching and nonteaching hospitals (p = 0.55). Conclusions The implementation of duty-hour restrictions was associated with an increased risk of postoperative complications for patients undergoing spine surgery. Therefore, contrary to its intended purpose, duty-hour reform may have resulted in worse patient outcomes. Additional studies are needed to evaluate strategies to mitigate these effects and assist in the development of future health care policy.

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Resident Operative Experience in General Surgery, Plastic Surgery, and Urology 5 Years After Implementation of the ACGME Duty Hour Policy

Abstract: The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

Cited by 54 publications

References 30 publications

Mentorship in Surgical Training: A Systematic Review

Mentorship in Surgical Training: A Systematic Review

Evidence-Based Education in Plastic Surgery

Morbidity, mortality, and health care costs for patients undergoing spine surgery following the ACGME resident duty-hour reform

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