Effects of Work Hour Reduction on Residents’ Lives

University of Chicago, Chicago, Illinois, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2005; 294(9):1088-100. DOI: 10.1001/jama.294.9.1088
Source: PubMed


The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents.
To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life.
We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings.
Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States.
For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form.
Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct.
Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.

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Available from: Steven Q Davis, Aug 23, 2015
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    • "Both decreased intern fatigue and the increased availability of independent study time for PGY-1 residents were highlighted. Such positives were also reported in the literature following the 2003 ACGME duty hour standards [7,8,13,17,21]. Whether these improvements in resident quality of life result in enhanced patient safety and better clinical outcomes is still being determined and the impact of these changes on resident education remain underexplored. A more recent study assessing sleep patterns among pediatric residents in a control group (every fourth night, 30-hour call) versus an intervention group adhering to the 2011 guidelines suggested that despite being better rested, residents in the intervention arm were often more stressed and reported a poorer educational experience compared to their control group counterparts due to the compression of their workload into a shorter day [22]. "
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    ABSTRACT: In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents. We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, "How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?" Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans. Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study. Residents noted a decline in teaching and are concerned with the decrease in "hands-on" clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education.
    Full-text · Article · Apr 2014 · BMC Medical Education
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    • "Research on physicians sleep deprivation has primarily focused on the detrimental impact of fatigue on patient care [9,10]. Various specialties, including Internal Medicine [6,7], Obstetrics and Gynecology [11], Pediatrics [12], have shown sleep deprivation among residents negatively affects performance [13,14]. Studies have identified many domains affected by fatigue impacting both physical and psychological disorders, ranging from an increased risk of depression [15], and heart disease [16], to professionalism, learning, errors, and completion of complex cognitive tasks [17-19]. "
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    ABSTRACT: Sleep deprivation among training physicians is of growing concern; training physicians are susceptible due to their prolonged work hours and rotating work schedules. The aim of this study was to determine the prevalence of self-perceived sleepiness in emergency training physicians, and to establish a relationship between self-perceived sleepiness, and quality of life. Prospective survey in Ibn Sina University hospital Center in Morocco from January to April 2011 was conducted. Questionnaires pertaining to socio-demographic, general, and sleep characteristics were completed by training physician who ensured emergency service during the month preceding the survey. They completed the Epworth sleepiness scale (ESS) which assessed the self-perceived sleepiness, and the EuroQol-5 dimensions (EQ-5D) scale which assessed the general quality of life. Total 81 subjects (49 men and 32 women) were enrolled with mean age of 26.1 +/- 3.4 years. No sleepiness was found in 24.7% (n = 20), excessive sleepiness 39.5% (n = 32), and severe sleepiness in 35.8% (n = 29) of training physicians. After adjusting for multiple confounding variables, four independent variables were associated with poorer quality of life index in training physician; unmarried (Ss -0.2, 95% CI -0.36 to -0.02; P = 0.02), no physic exercise (Ss -0.2, 95% CI -0.39 to 0.006; P = 0.04), shift-off sleep hour less than 6 hours (Ss -0.13, 95% CI -0.24 to -0.02; P = 0.01), and severe sleep deprivation(Ss -0.2, 95% CI -0.38 to -0.2; P = 0.02). Nearly two third of training physicians had suffered from sleepiness. There is an association between poor quality of life and severe sleepiness in unmarried physicians, sleeping less than 6 hours in shift-off day, and doing no physical activity.
    Full-text · Article · Sep 2013 · Journal of Occupational Medicine and Toxicology
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    • "One approach is the night float rotation system, whereby residents provide patient care either during daytime shifts or during 12 to 16 hour overnight shifts [3,9,10,12,16]. Despite research showing the benefits of reduced consecutive duty hours and night float rotations, some contradictory evidence continues to emerge about the impact on residents’ wellness, ability to deliver health care and medical education experience [9,12,14,20-22]. Night float rotations can cause disruptions in basic biological functions, circadian rhythms, social relationships, and psycho-physical health [23]. "
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    ABSTRACT: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality healthcare, and medical education experience. This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.
    Full-text · Article · Aug 2013 · BMC Medical Education
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