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Work-hour restrictions and orthopaedic resident education: a systematic review

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Abstract

Purpose

The ACGME (US) and The European Working Time Directive (UK) placed work-hour restrictions on medical trainees with the goal of improved patient safety. However, there has been concern over a potential decrease in medical education. Orthopaedic training is the focus of this study. We examined previously published subjective and objective data regarding education and work-hour restrictions and developed the questions: Do specific perceptions emerge within the subjective studies examined? Are there objective differences in educational measures before and after work-hour restrictions? Is there a difference between the subjective and objective data?

Methods

A systematic review was conducted via MedLine, regarding orthopaedic studies in the USA and UK, with reference to work-hour restrictions and education.

Results

Subjective survey studies demonstrate that residents and attending physicians have a negative response to work-hour restrictions because of the perceived impact on their overall education and operating room experience. Conversely, limited objective studies demonstrated no change in operative volume before or after implementation of restrictions.

Conclusions

This review highlights the need for more objective studies on the educational implications of work-hour restrictions. Studies to date have not demonstrated a measurable difference based on case logs or training scores. Opinion-based surveys demonstrate an overall negative perception by both residents and attending physicians, on the impact of work-hour restrictions on orthopaedic education. Current published data is limited and stronger evidence-based data are needed before definitive conclusions can be reached.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Robert T. Stafford Hall, 4th Floor 95 Carrigan Drive, Burlington, VT, 05405-0084, USA

    Nathan S. Mauser & James D. Michelson

  2. Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    Hannah Gissel, Corey Henderson & Cyril Mauffrey

Authors
  1. Nathan S. Mauser
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  2. James D. Michelson
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  3. Hannah Gissel
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  4. Corey Henderson
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  5. Cyril Mauffrey
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Corresponding author

Correspondence to Cyril Mauffrey.

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The authors report no external funding source for this study.

Conflict of interest statement

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Mauser, N.S., Michelson, J.D., Gissel, H. et al. Work-hour restrictions and orthopaedic resident education: a systematic review. International Orthopaedics (SICOT) 40, 865–873 (2016). https://doi.org/10.1007/s00264-015-3045-7

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  • DOI: https://doi.org/10.1007/s00264-015-3045-7

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