The Perspective of the Vascular Surgery Trainee on New ACGME Regulations, Fatigue, Resident Training, and Patient Safety

Abstract

Vascular surgery trainees are concerned about further duty-hour restrictions on patient care, education, and training and fatigue mitigation has to be balanced against the need to adequately train vascular surgeons.

A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery

“…Nine of the 17 articles examined the impact of 16-hour duty hour restrictions on resident wellness; 2 articles using validated measures (eg, Maslach Burnout Inventory) concluded there has been no significant change. Eight articles examined the perceived impact; 3 (38%) reported improvement,64,70,72 1 (13%) suggested wellness was worse,67 1 (13%) reported no significant change,37 and 3 (38%) had unclear results 4,65,71. Validated tools suggest no significant change after RDH restrictions; findings from the perceived impact are unclear.…”

“…Fifteen articles evaluated impact of the 16-hour duty maximums on resident education; 2 objectively assessed the impact and concluded education was worse (eg, examination data and/or clinical performance) 38,55. Fourteen examined the perceived impact; 12 (86%) articles concluded that education is worse4,36,38,64–72 and 2 (14%) reported no significant change 22,35,37. Overall, both the objective and perceived impact findings support a trend toward worsened outcomes.…”

“…Two studies showed worsened educational outcomes using examination data, access to operating room (OR) times, and clinical performance;38,55 in 1 study, the overall impact could not be determined 43. In more than half of the studies (6, 55%) using self-reported survey data, residents believed that their wellness had improved after 16-hour shift restrictions and/or the implementation of night float systems 43,64,70,72–74. Seventeen surveys queried self-reported educational outcomes and 12 (71%) surveys showed that educational outcomes were believed to have worsened;4,36,38,64–72 only 1 (6%) survey reported improved educational outcomes 73.…”

“…In more than half of the studies (6, 55%) using self-reported survey data, residents believed that their wellness had improved after 16-hour shift restrictions and/or the implementation of night float systems 43,64,70,72–74. Seventeen surveys queried self-reported educational outcomes and 12 (71%) surveys showed that educational outcomes were believed to have worsened;4,36,38,64–72 only 1 (6%) survey reported improved educational outcomes 73. Sixteen survey studies examined the effects of 16-hour or night float systems on perceptions of patient safety; 12 (75%) reported a perception of worsened patient outcomes,4,35–38,64–69,73 whereas 1 (6%) survey reported improved perceptions of patient safety 74…”

Effects of Fatigue on Driving Safety: A Comparison of Brake Reaction Times in Night Float and Postcall Physicians in Training

“…Changes in work hours have caused significant controversy, and some opponents have cited poor continuity of care and inadequate training time for residents. [2][3][4] Conversely, proponents of duty hour limits believe eliminating physician fatigue could minimize medical errors. [5][6][7] Studies have suggested that resident physicians are prone to committing errors, and exhibit diminished surgical skills when postcall.…”