PERSPECTIVES ON WORK-HOUR RESTRICTIONS AMONG GENERAL SURGERY RESIDENTS
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Keywords
Work-hour restrictions, General surgery residency, Surgical training, Resident perceptions
Abstract
The researchers were keen to learn what general surgery physicians think about the idea of restricted work hours. The survey examined what residents think about the effects an 80-hour workweek might have on how long it takes to train, gain surgical experience, get an education and on total well-being. Responses from senior and junior residents were compared by using Fisher’s method. The survey results include 158 replies from 360 residents in the community: 70 from seniors and 88 from juniors. A large portion, 79%, said they worked between 75 and 100 hours each week. A lower percentage of juniors (43%) believed reducing work would reduce their chance to perform surgery than did senior residents (74%) (p < 0.001). A majority from both groups thought cutting work hours would make their lives better (86% vs. 96%, p = 0.12). Most residents, at 60%, said they did not expect longer training because of the new rules. About half of juniors thought that 24-hour shifts were bad for their health, but only a quarter of seniors agreed (p = 0.001). Still, both sides agreed that removing overnight surgery could decrease surgeons’ risk of exposure (84% vs. 70%). Fewer than one-third of people in the area backed the idea to no longer have emergency care available around the clock. In addition, 47% (41% of seniors, 51% of juniors, p = 0.26) expressed agreement with the suggestion of working 80 hours weekly. Senior general surgery residents in Canada see the rules about work hours differently than junior residents. Even though some believe in limiting workweeks, neither group is really in favor of the 80-hour workweek or bringing back 24-hour call.
References
2.Asch DA, Parker RM. The Libby Zion case. One step forward or two steps backward? N Engl J Med. 1988;318:771–5.
3.Brensilver JM, Smith L, Lyttle CS. Impact of the Libby Zion case on graduate medical education in internal medicine. Mt Sinai J Med. 1998;65:296–300.
4.Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141:851–7.
5.Lockley SW, Landrigan CP, Barger LK, et al. Harvard Work Hours Health and Safety Group. When policy meets physiology: the challenge of reducing resident work hours. Clin Orthop Relat Res. 2006;449:116–27.
6.Griner D, Menon RP, Kotwall CA, et al. The eighty-hour workweek: surgical attendings’ perspectives. J Surg Educ. 2010;67:25–31.
7.Jagannathan J, Vates GE, Pouratian N, et al. Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity. J Neurosurg. 2009;110:820–7.
8.Mitchell CD, Mooty CR, Dunn EL, et al. Resident fatigue: Is there a patient safety issue? Am J Surg. 2009;198:811–6.
9.Riesenberg LA, Leitzsch J, Massucci JL, et al. Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med. 2009;84:1775–87.
10.Vidyarthi AR, Auerbach AD, Wachter RM, et al. The impact of duty hours on resident self reports of errors. J Gen Intern Med. 2007;22:205–9.
11.Landrigan CP, Fahrenkopf AM, Lewin D, et al. Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics. 2008;122:250–8.
12.Nakayama DK, Thompson WM, Wynne JL, et al. The effect of ACGME duty hour restrictions on operative continuity of care. Am Surg. 2009;75:1234–7.
13.Resnick AS, Todd BA, Mullen JL, et al. How do surgical residents and non-physician practitioners play together in the sandbox? Curr Surg. 2006;63:155–64.
14.Pezzi C, Leibrandt T, Suryadevara S, et al. The present and future use of physician extenders in general surgery training programs: one response to the 80-hour work week. J Am Coll Surg. 2009;208:587–91.
15.Buch KE, Genovese MY, Conigliaro JL, et al. Non-physician practitioners’ overall enhancement to a surgical resident’s experience. J Surg Educ. 2008;65:50–3.
16.Moalem J, Salzman P, Ruan DT, et al. Should all duty hours be the same? Results of a national survey of surgical trainees. J Am Coll Surg. 2009;209:47–54.
17.Kelly RJ, Jr, Senkowski CK. Effect of the night float system on operative case volume for senior surgical residents. J Surg Educ. 2009;66:314–8.
18.Kairys JC, McGuire K, Crawford A, et al. Cumulative operative experience is decreasing during general surgery residency: A worrisome trend for surgical trainees? J Am Coll Surg. 2008;206:804–11.
19.Kairys JC, DiMuzio PJ, Crawford AG, et al. Changes in operative case experience for general surgery residents: Has the 80-hour work-week decreased residents’ operative experience? Adv Surg. 2009;43:73–90.
20.Feanny MA, Scott BG, Mattox KL, et al. Impact of the 80-hour work-week on resident emergency operative experience. Am J Surg. 2005;190:947–9.
21.Carlin AM, Gasevic E, Shepard AD. Effect of the 80-hour work-week on resident operative experience in general surgery. Am J Surg. 2007;193:326–29.
22.Curet MJ. Resident work hour restrictions: Where are we now? J Am Coll Surg. 2008;207:767–76.
23.Willis RE, Coverdill JE, Mellinger JD, et al. Views of surgery program directors on the current ACGME and proposed IOM duty-hour standards. J Surg Educ. 2009;66:216–21.
24.Chung R, Ahmed N, Chen P. Meeting the 80-hour work-week requirement: What did we cut? Curr Surg. 2004;61:609–11.
25.Newton DA, Grayson MS. Trends in career choice by US medical school graduates. JAMA. 2003;290:1179–82.
26.Tambyraja AL, McCrea CA, Parks RW, et al. Attitudes of medical students toward careers in general surgery. World J Surg. 2008;32:960–3.
27.Barshes NR, Vavra AK, Miller A, et al. General surgery as a career: a contemporary review of factors central to medical student specialty choice. J Am Coll Surg. 2004;199:792–9.
28.Scott IM, Matejcek AN, Gowans MC, et al. Choosing a career in surgery: factors that influence Canadian medical students’ interest in pursuing a surgical career. Can J Surg. 2008;51:371–7.
29.Kirkham JC, Widmann WD, Leddy D, et al. Medical student entry into general surgery increases with early exposure to surgery and to surgeons. Curr Surg. 2006;63:397–400.
30.Morrison CA, Wyatt MM, Carrick MM. Impact of the 80-hour work week on mortality and morbidity in trauma patients: an analysis of the National Trauma Data Bank. J Surg Res. 2009;154:157–62.
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Dr. M. Viswa Bhushana Raghuveer
Assistant Professor, Department of General Surgery, Bhaarath Medical College & Hospital, Chennai - 600073