To determine whether the 80-hour resident workweek adversely affects patient outcomes or resident education.
To assess patient outcomes, the authors reviewed trauma patient morbidity and mortality at the second busiest level I trauma center in Los Angeles County before (July 1998-June 2003, Period 1) and after (July 2003-June 2005, Period 2) implementation of the duty hour limitation via a retrospective review of a prospective database. All patients were operated and managed by residents under faculty supervision. Patient characteristics included the injury severity score (ISS), mechanism of injury, complications, and death. To assess resident education, the authors compared ABSITE percentile scores, first-time pass rates on the American Board of Surgery Qualifying and Certifying Examinations, and total and chief resident operative case volumes. In addition, they estimated institutional costs incurred to comply with the new duty hour rules.
Patient outcomes. Over the entire 7-year study period, 11,518 trauma patients were transported to Harbor-UCLA Medical Center. Compared with Period 1, Period 2 experienced an increase in average yearly patient volume from 1510 to 1981 (p 0.01). The average ISS also increased, from 7.9 to 9.6 (p < 0.0001), as did the proportion of penetrating trauma from 14.8% to 17.6% (p < 0.0001). Morbidity and mortality rates remained unchanged. Resident education. Mean ABSITE scores and first-time Qualifying and Certifying Exam pass rates were unchanged. Mean resident total major case volumes increased significantly in Period 2 from 831 to 1156 (p < 0.0001), whereas chief resident year case volumes were unchanged. The estimated cost incurred by this institution to conform to the new work hour standards was approximately 359,000 dollars per year.
Despite concerns that the 80-hour workweek might threaten patient care and resident education, the morbidity and mortality rates at a busy level I trauma center remained unchanged. The quality of surgical resident education, as measured by operative volumes, ABSITE scores, and written and oral board examination pass rates were likewise unchanged. The reorganization of the authors' general surgery residency program to comply with the duty hour restrictions was achieved within reasonable cost.
[Show abstract][Hide abstract] ABSTRACT: The restriction of the resident physician work week to 80 hours has had dramatic affects on resident education and life-style. While effects on mood, psychological distress, and burn-out have been studied, the resultant changes in tangible quality of life have received little attention. Birth rate was considered a measurable, relevant outcome. The resident marital and parental status by duty month was collected from a single orthopaedic surgical residency program for the four academic years preceding and following the implementation of the 80-hour work week. The number of births to residents during these periods were also tallied. The relative prevalence of positive marital status changed very little between residents in the two time durations from 66 to 71 percent, but parental status increased from 27 to 43 percent. The number of births per married resident duty year also increased from 0.23 pre-restrictions to 0.32 post-restrictions. While the individual decisions involved in generating these observed changes are complex and difficult to entirely decipher, it is thought that an increased perception of life-control within the work-hour restrictions may have prompted the dramatic changes in birth rate among resident families.
[Show abstract][Hide abstract] ABSTRACT: Major changes in surgical practice and myriad external mandates have affected residency education in surgery. The traditional surgery residency education and training model has come under scrutiny, and calls for major reform of this model have been made by a variety of stakeholders. The American Surgical Association appointed a Blue Ribbon Committee in 2002 to consider the recent changes in surgical practice and surgical education and propose solutions that would ensure a well-educated and well-trained surgical workforce for the future. This committee included representatives from the American Surgical Association, the American College of Surgeons, the American Board of Surgery, and the Residency Review Committee for Surgery. The committee made several far-reaching recommendations relating to residency education in surgery. After the Blue Ribbon Committee completed its task in 2004, representatives from the aforementioned four organizations, the Association of Program Directors in Surgery, and the Association for Surgical Education created a national consortium called the Surgical Council on Resident Education (SCORE). This consortium is pursuing efforts to reform residency education in surgery and implement several key recommendations of the Blue Ribbon Committee. The principal area of focus of SCORE is the development of a national curriculum for surgery residency education and training. Other activities of SCORE include the development of a Web site to support surgery residency education and pursuit of international collaboration. SCORE's efforts will be key to offering surgery residents the best educational experiences, preparing residents for future practice, and supporting delivery of surgical care of the highest quality. The authors examine the current state of residency education in surgery and explore efforts underway to reform this educational model.
Academic Medicine 01/2008; 82(12):1200-10. DOI:10.1097/ACM.0b013e318159e052 · 2.93 Impact Factor
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