Internal medicine residents’ clinical and didactic experiences after work hour regulation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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 (2004) In pursuit of optimal duty hours and resident experiences. J Gen Intern Med 19: pp. 97-8 CrossRef
- Fletcher, KE, Underwood, W, Davis, SQ, Mangrulkar, RS, McMahon, LF, Saint, S (2005) Effects of work hour reduction on residents’ lives: a systematic review. JAMA 294: pp. 1088-100 CrossRef
- Goitein, L, Shanafelt, TD, Wipf, JE, Slatore, CG, Back, AL (2005) The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med 165: pp. 2601-6 CrossRef
- Gopal, R, Glasheen, JJ, Miyoshi, TJ, Prochazka, AV (2005) Burnout and internal medicine resident work-hour restrictions. Arch Intern Med 165: pp. 2595-600 CrossRef
- Lin, GA, Beck, DC, Garbutt, JM (2006) Residents’ perceptions of the effects of work hour limitations at a large teaching hospital. Acad Med 81: pp. 63-7 CrossRef
- Vidyarthi, AR, Katz, PP, Wall, SD, Wachter, RM, Auerbach, AD (2006) Impact of reduced duty hours on residents’ educational satisfaction at the University of California, San Francisco. Acad Med 81: pp. 76-81 CrossRef
- New York Health Code, 10 NYCRR Sect 405.4 (1989).
- Nuckols, TK, Escarce, JJ (2005) Residency work-hours reform. A cost analysis including preventable adverse events. J Gen Intern Med 20: pp. 873-8 CrossRef
- Barden, CB, Specht, MC, McCarter, MD, Daly, JM, Fahey, TJ (2002) Effects of limited work hours on surgical training. J Am Coll Surg 195: pp. 531-8 CrossRef
- Gelfand, DV, Podnos, YD, Carmichael, JC, Saltzman, DJ, Wilson, SE, Williams, RA (2004) Effect of the 80-hour workweek on resident burnout. Arch Surg 139: pp. 933-8 CrossRef
- Hassett, JM, Nawotniak, R, Cummiskey, D (2002) Maintaining outcomes in a surgical residency while complying with resident working hour regulations. Surgery 132: pp. 635-9 CrossRef
- Mendoza, KA, Britt, LD (2005) Resident operative experience during the transition to work-hour reform. Arch Surg 140: pp. 137-45 CrossRef
- Spencer, AU, Teitelbaum, DH (2005) Impact of work-hour restrictions on residents’ operative volume on a subspecialty surgical service. J Am Coll Surg 200: pp. 670-6 CrossRef
- Johnson, T (2003) Limitations on residents’ working hours at New York teaching hospitals: a status report. Acad Med 78: pp. 3-8 CrossRef
- FitzGerald, JD, Wenger, NS (2003) Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores?. Acad Med 78: pp. 84-9 CrossRef
- Landrigan, CP, Rothschild, JM, Cronin, JW (2004) Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 351: pp. 1838-48 CrossRef
- Lim, KG, Dunn, WF, Klarich, KW, Afessa, B (2005) 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 33: pp. 1534-7 CrossRef
- Reader, DW, Spigos, DG, Bennett, WF, Mueller, CF, Vaswani, KK (2002) The graveyard shift: experience with a night float system. Emerg Radiol 9: pp. 82-7
- Buff, DD, Shabti, R (1995) The night float system of resident on call: what do the nurses think?. J Gen Intern Med 10: pp. 400-2 CrossRef
- Trontell, MC, Carson, JL, Taragin, MI, Duff, A (1991) The impact of the night float system on internal medicine residency programs. J Gen Intern Med 6: pp. 445-9 CrossRef
- Wong, JG, Holmboe, ES, Huot, SJ (2004) Teaching and learning in an 80-hour work week: a novel day-float rotation for medical residents. J Gen Intern Med 19: pp. 519-23 CrossRef
- Parekh, VI, Sharpe, B, Fletcher, KE, Cornia, P, Vidyarthi, A (2005) The impact of resident work hours limits on internal medicine residents’ continuity clinic experience. J Gen Intern Med 20: pp. 165-165 CrossRef
- Internal medicine residents’ clinical and didactic experiences after work hour regulation
Journal of General Internal Medicine
Volume 21, Issue 9 , pp 961-965
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- 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