, Volume 21, Issue 9, pp 961-965

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.

This paper was presented as a poster at the annual meeting of the Society of General Internal Medicine on April 28, 2006.
Dr. Horwitz is supported by the Department of Veterans Affairs and the Robert Wood Johnson Clinical Scholars Program, which had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication.