Internal medicine residents’ clinical and didactic experiences after work hour regulation
A survey of chief residents
Received: 27 December 2005 Revised: 20 February 2006 Accepted: 28 March 2006 DOI:
Cite this article as: Horwitz, L.I., Krumholz, H.M., Huot, S.J. et al. J GEN INTERN MED (2006) 21: 961. doi:10.1007/BF02743145 Abstract Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. BACKGROUND: To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. OBJECTIVE: Cross-sectional mail survey. DESIGN: Chief residents at all accredited U.S. internal medicine residency programs outside New York. PARTICIPANTS: 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, MEASUREMENTS AND MAIN RESULTS: P=.12), but 56% of programs reported a decrease in intern attendance at educational activities. 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. CONCLUSIONS: Key Words internship and residency workload education personnel staffing scheduling
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.
Download to read the full article text References
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.
. In pursuit of optimal duty hours and resident experiences. J Gen Intern Med. 2004;19:97–8.
Fletcher KE, Underwood W
Davis SQ, Mangrulkar RS, McMahon LF
. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294:1088–100.
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.
Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV
. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.
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.
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.
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.
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.
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.
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.
Mendoza KA, Britt LD
. Resident operative experience during the transition to work-hour reform. Arch Surg. 2005;140:137–45.
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.
. Limitations on residents’ working hours at New York teaching hospitals: a status report. Acad Med. 2003;78:3–8.
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.
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.
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.
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.
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.
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.
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 Copyright information
© Society of General Internal Medicine 2006