Internal medicine residents’ clinical and didactic experiences after work hour regulation
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BACKGROUND: Work hour regulations for house staff were intended in part to improve resident clinical and educational performance.
OBJECTIVE: To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education.
DESIGN: Cross-sectional mail survey.
PARTICIPANTS: Chief residents at all accredited U.S. internal medicine residency programs outside New York.
MEASUREMENTS AND MAIN RESULTS: The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4,P=.12), but 56% of programs reported a decrease in intern attendance at educational activities.
CONCLUSIONS: In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents’ inpatient clinical experience. Hours allotted to educational activities did not change: however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.
- The Patient and Physician Safety Act of 2001, H. R. 3236, 107th Congress, First Session, 2001.
- Petition to the Occupational Safety and Health Organization requesting that limits be placed on hours worked by medical residents (HRG Publication #1570). Available at: http://www.citizen.org/publications/release.cfm?ID=6771. Accessed March 6, 2006.
- Accreditation Council for Graduate Medical Education. Common program requirements (resident duty hours). Available at: http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursCommonPR.pdf. Accessed March 6, 2006.
- Accreditation Council for Graduate Medical Education. The ACGME’s approach to limit resident duty hours 12 months after implementation: a summary of achievements. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursummary2003-04.pdf. Accessed March 6, 2006.
- Accreditation Council for Graduate Medical Education. Statement of justification/impact for the final approval of common standards related to resident duty hours. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_impactStatement.pdf. Accessed March 6, 2006.
- Wilson MC. In pursuit of optimal duty hours and resident experiences. J Gen Intern Med. 2004;19:97–8. CrossRef
- Fletcher KE, Underwood W III,Davis SQ, Mangrulkar RS, McMahon LF Jr,Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294:1088–100. CrossRef
- Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165:2601–6. CrossRef
- Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600. CrossRef
- Lin GA, Beck DC, Garbutt JM. Residents’ perceptions of the effects of work hour limitations at a large teaching hospital. Acad Med. 2006;81:63–7. CrossRef
- Vidyarthi AR, Katz PP, Wall SD, Wachter RM, Auerbach AD. Impact of reduced duty hours on residents’ educational satisfaction at the University of California, San Francisco. Acad Med. 2006;81:76–81. CrossRef
- New York Health Code, 10 NYCRR Sect 405.4 (1989).
- Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse events. J Gen Intern Med. 2005;20:873–8. CrossRef
- Barden CB, Specht MC, McCarter MD, Daly JM, Fahey TJ III. Effects of limited work hours on surgical training. J Am Coll Surg. 2002;195:531–8. CrossRef
- Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA. Effect of the 80-hour workweek on resident burnout. Arch Surg. 2004;139:933–8; discussion 8–40. CrossRef
- Hassett JM, Nawotniak R, Cummiskey D, et al. Maintaining outcomes in a surgical residency while complying with resident working hour regulations. Surgery. 2002;132:635–9; discussion 9–41. CrossRef
- Mendoza KA, Britt LD. Resident operative experience during the transition to work-hour reform. Arch Surg. 2005;140:137–45. CrossRef
- Spencer AU, Teitelbaum DH. Impact of work-hour restrictions on residents’ operative volume on a subspecialty surgical service. J Am Coll Surg. 2005;200:670–6. CrossRef
- Johnson T. Limitations on residents’ working hours at New York teaching hospitals: a status report. Acad Med. 2003;78:3–8. CrossRef
- FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78:84–9. CrossRef
- Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–48. CrossRef
- Lim KG, Dunn WF, Klarich KW, Afessa B. Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions. Crit Care Med. 2005;33:1534–7. CrossRef
- Reader DW, Spigos DG, Bennett WF, Mueller CF, Vaswani KK. The graveyard shift: experience with a night float system. Emerg Radiol. 2002;9:82–7.
- Buff DD, Shabti R. The night float system of resident on call: what do the nurses think? J Gen Intern Med. 1995;10:400–2. CrossRef
- Trontell MC, Carson JL, Taragin MI, Duff A. The impact of the night float system on internal medicine residency programs. J Gen Intern Med. 1991;6:445–9. CrossRef
- Wong JG, Holmboe ES, Huot SJ. Teaching and learning in an 80-hour work week: a novel day-float rotation for medical residents. J Gen Intern Med. 2004;19:519–23. CrossRef
- Parekh VI, Sharpe B, Fletcher KE, Cornia P, Vidyarthi A. The impact of resident work hours limits on internal medicine residents’ continuity clinic experience. J Gen Intern Med. 2005;20:165. CrossRef
- Internal medicine residents’ clinical and didactic experiences after work hour regulation
Journal of General Internal Medicine
Volume 21, Issue 9 , pp 961-965
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- internship and residency
- personnel staffing
- Industry Sectors
- Author Affiliations
- 1. VA Connecticut Healthcare System, West Haven, CT, USA
- 2. Robert Wood Johnson Clinical Scholar, Yale University School of Medicine, IE-61 SHM, PO Box 208088, 06520-8088, New Haven, CT
- 3. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA