Original Article

Journal of General Internal Medicine

, Volume 22, Issue 7, pp 969-975

First online:

Resident Perceptions of the Impact of Work Hour Limitations

  • Grace A. LinAffiliated withDivision of General Internal Medicine, University of California, San Francisco Email author 
  • , David C. BeckAffiliated withUniversity of Cincinnati College of Medicine
  • , Anita L. StewartAffiliated withInstitute of Health & Aging University of California, San Francisco
  • , Jane M. GarbuttAffiliated withDivision of General Medical Sciences, Washington University School of Medicine

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Mandatory work hour limitations for residents began in July 2003. There has been little evaluation of the impact of the new limitations on Internal Medicine residency training.


To assess Internal Medicine residents’ perceptions of the impact of work hour limitations on clinical experiences, patient care, resident education, and well-being, and their compliance with the limitations.


Cross-sectional survey administered to Internal Medicine residents at 1 large U.S. teaching hospital.


Resident perceptions using 5-point Likert scales, and self-reported compliance. Exploratory factor analysis was used to identify underlying domains and develop scales.


The survey response rate was 85%. Five domains were identified by factor analysis: 1) clinical experience, 2) patient care and safety, 3) communication, 4) satisfaction with training, and 5) work–rest balance. Residents perceived work hour limitations to have a negative impact on clinical experience (mean scale score 1.84, 1 = negative, 5 = positive), patient care and safety (2.64), and communication domains (1.98). Effects on satisfaction (3.12) and work–rest balance domains (2.95) were more positive. Senior residents perceived more negative effects of work hour limitations than interns. Compliance was difficult; 94% interns and 70% residents reported violating work hour limits. Patient care and teaching duties were the main reasons for work hour violations.


This study suggests that the current work hour limitations may be having unintended negative consequences on residency training. Ongoing monitoring to evaluate the impact of program changes as a result of work hour regulation is crucial to improving residency training.


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