Many Surgical Residents Say Current Duty Hour Restrictions Put Safety At Risk

Heather Comak, for HealthLeaders Media , July 15, 2009

A significant portion of surgical residents think the hours imposed on their work schedules inhibit their surgical education and puts patients' safety at risk, according to a study published in the July Journal of the American College of Surgeons. Although not a majority, 41% of surgical residents included in the study felt that the duty hour regulations implemented by the Accreditation Council for Graduate Medical Education (ACGME) presented a "moderate barrier" to their surgical education.

The duty hour regulations were originally put in place by the ACGME in 2003 in an effort to prevent surgical errors, keep patients safer, and give residents more time on their own by acknowledging that overtired residents are more prone to make mistakes. Currently surgical residents are required to work no more than 80 hours in a week, and have no less than 10 hours between shifts. The Institute of Medicine is recommending that residents working any overnight shifts of 30 hours or longer be given time to nap and that residents work no longer than a 16 hour shift without sleep.

Because of the ACGME hour restrictions, surgical residents do report getting more sleep and having more time for their personal lives. However, a significant of surgical residents percentage are reporting that they think patients' safety is being negatively affected by the hour restrictions due to increased patient handoffs and lack of continuity of care. Forty-three percent of respondents felt that the ideal work week would be between 80 and 100 hours, while 52% thought that the 60-80 hours was adequate.

"We were surprised to find that nearly half of surgical residents believe work-hour restrictions are actually an impediment to their training," said Jacob Moalem, MD, Department of Surgery, University of Rochester (NY) Medical Center, and lead author of the study. "Our current system limits educational opportunities for surgeons who are expressing a desire and a need to learn more in a compact timeframe. Senior surgery residents should be given the chance to control their own schedules as they continue to refine their technical skills and transition into independent practice."

The study surveyed resident and associate members of the American College of Surgeons electronically, of which 599 responded. They were asked to rate if the duty hour regulations affected their surgical education, and also what the appropriate number of hours per week they think should be worked during their postgraduate year from the choices of less than 60, 60 to 80, 80 to 100, or more than 100.

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