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The impact of 2011 ACGME duty hour restrictions on internal medicine resident workload and education

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Abstract

The Accreditation Council for Graduate Medical Education (ACGME) implemented work hour restrictions for physicians in training in 2003 that were revised July 1, 2011. Current published data are insufficient to assess whether such work hour restrictions will have long-term impact on residents’ education. We searched computer-generated reports of hospital in-patient census, continuity clinic census, in-training exam scores and first-year resident attendance at educational conferences for the academic years 2010–2011 (August 1, 2010—May 31, 2011) and 2011–2013 (August 1, 2011—May 31, 2013). During the first year of the study period, the residents’ inpatient internal medicine services admitted 1,754 patients; during this same period for academic years 2011–2012 and 2012–2013, the teaching services admitted 1,539 and 1,428 patients respectively, yielding a decrease of 16.4 %. Monthly, these services cared for a mean of 27.1 (27.1/175.4 [15.4 %]) fewer patients and 9.7 (9.7/34.4 [28.2 %]) fewer patients per intern than in the previous year. No statistical difference was observed regarding continuity clinic attendance and in-training exam scores. Residents in the years following work hours restrictions attended more educational conferences. Implementation of 2011 ACGME work hour regulations resulted in fewer patients seen by first-year residents in hospital, but did not affect in-training exam scores. Whether these findings will translate into differences in patient outcomes, and quality of care remains to be seen.

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Abbreviations

ACGME:

Accreditation Council for Graduate Medical Education

PGY1:

Postgraduate year 1

ITE:

In-training exam

References

  • Alpert, J. S., & Frishman, W. H. (2012). A bridge too far: A critique of the new ACGME duty hour requirements. American Journal of Medicine, 125, 1–2.

    Article  Google Scholar 

  • Charap, M. (2004). Reducing resident work hours: Unproven assumptions and unforeseen outcomes. Annals of Internal Medicine, 140, 814–815.

    Article  Google Scholar 

  • Cowie, C. J., Pesic-Smith, J. D., Boukas, A., & Nelson, R. J. (2013). Has the impact of the working time regulations changed neurosurgical trainees’ attitudes toward the european working time directive 5 years on? British Journal of Neurosurgery, 27, 580–585.

    Article  Google Scholar 

  • Durkin, E. T., McDonald, R., Munoz, A., & Mahvi, D. (2008). The impact of work hour restrictions on surgical resident education. Journal of Surgical Education, 65, 54–60.

    Article  Google Scholar 

  • Emanuel, E. J., & Fuchs, V. R. (2012). Shortening medical training by 30 %. JAMA, 307, 1143–1144.

    Article  Google Scholar 

  • Fletcher, K. E., Underwood, W., 3rd, Davis, S. Q., Mangrulkar, R. S., McMahon, L. F., Jr, & Saint, S. (2005). Effects of work hour reduction on residents’ lives: A systematic review. JAMA, 294, 1088–1100.

    Article  Google Scholar 

  • Goddard, A. F. (2008). Progress on the european working time directive (EWTD) and new deal negotiations. Clinical Medicine, 11, 420–421.

    Article  Google Scholar 

  • Hutter, M. M., Kellogg, K. C., Ferguson, C. M., Abbott, W. M., & Warshaw, A. L. (2006). The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Annals of Surgery, 243, 864–871.

    Article  Google Scholar 

  • Institute of Medicine, Committee on Quality of Health Care in America. (2000). To err is human: Building a safer health system. Washington (DC): National Academies Press.

    Google Scholar 

  • Irani, J. L., Mello, M. M., Ashley, S. W., Whang, E. E., Zinner, M. J., & Breen, E. (2005). Surgical residents’ perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery, 138, 246–253.

    Article  Google Scholar 

  • Jamal, M. H., Rousseau, M. C., Hanna, W. C., Doi, S. A., Meterissian, S., & Snell, L. (2011). Effect of the ACGME duty hours restrictions on surgical residents and faculty: A systematic review. Academic Medicine, 86, 34–42.

    Article  Google Scholar 

  • Landrigan, C. P., Fahrenkopf, A. M., Lewin, D., Sharek, P. J., Barger, L. K., Eisner, M., et al. (2008). Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics, 122, 250–258.

    Article  Google Scholar 

  • Landrigan, C. P., Rothschild, J. M., Cronin, J. W., Kaushal, R., Burdick, E., Katz, J. T., et al. (2004). Effect of reducing interns’ work hours on serious medical errors in intensive care units. New England Journal of Medicine, 351, 1838–1848.

    Article  Google Scholar 

  • McLean, T. R. (2005). The 80-hour work week: why safer patient care will mean more health care is provided by physician extenders. Journal of Legal Medicine, 26, 339–384.

    Article  Google Scholar 

  • Moonesinghe, S. R., Lowery, J., Shahi, N., Millen, A., & Beard, J. D. (2011). Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: Systematic review. BMJ, 342, d1580.

    Article  Google Scholar 

  • Myers, J. S., Bellini, L. M., Morris, J. B., Graham, D., Katz, J., Potts, J. R., et al. (2006). Internal medicine and general surgery residents’ attitudes about the ACGME duty hours regulations: a multicenter study. Academic Medicine, 81, 1052–1058.

    Article  Google Scholar 

  • Nasca, T. J., Day, S. H., & Amis, E. S., Jr. (2010). ACGME duty hour task force. The new recommendations on duty hours from the ACGME task force. New England Journal of Medicine, 363, e3.

    Article  Google Scholar 

  • National Research Council, Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety. (2009). Resident duty hours: Enhancing sleep, supervision, and safety. Washington, DC: National Academies Press.

  • Pellegrini, V. D., Jr. (2012). Perspective: ten thousand hours to patient safety, sooner or later. Academic Medicine, 87, 164–167.

    Article  Google Scholar 

  • Philibert, I., Friedmann, P., & Williams, W. T. (2000). ACGME work group on resident duty hours. Accreditation Council for Graduate Medical Education: New requirements for resident duty hours. JAMA, 288, 1112–1114.

    Article  Google Scholar 

  • Press, M. J., Silber, J. H., Rosen, A. K., Romano, P. S., Itani, K. M., Zhu, J., et al. (2011). The impact of resident duty hour reform on hospital readmission rates among Medicare beneficiaries. Journal of General Internal Medicine, 26, 405–411.

    Article  Google Scholar 

  • Richter, A., Kostova, P., Baur, X., & Wegner, R. (2014). Less work: More burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU working time directive. International Archives of Occupational and Environmental Health, 87, 205–215.

    Article  Google Scholar 

  • Shetty, K. D., & Bhattacharya, J. (2007). Changes in hospital mortality associated with residency work-hour regulations. Annals of Internal Medicine, 147, 73–80.

    Article  Google Scholar 

  • Swide, C. E., & Kirsch, J. R. (2007). Duty hours restriction and their effect on resident education and academic departments: The American perspective. Current Opinion in Anesthesiology, 20, 580–584.

    Article  Google Scholar 

  • Thanarajasingam, U., McDonald, F. S., Halvorsen, A. J., Naessens, J. M., Cabanela, R. L., Johnson, M. G., et al. (2012). Service census caps and unit-based admissions: Resident workload, conference attendance, duty hour compliance, and patient safety. Mayo Clinic Proceedings, 87, 320–327.

    Article  Google Scholar 

  • Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Even-Shoshan, O., Wang, Y., et al. (2007). Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA, 298, 975–983.

    Article  Google Scholar 

  • Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Itani, K. M., Bellini, L., et al. (2009). Did duty hour reform lead to better outcomes among the highest risk patients? Journal of General Internal Medicine, 24, 1149–1155.

    Article  Google Scholar 

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Correspondence to Darko Vucicevic.

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Vucicevic, D., Mookadam, F., Webb, B.J. et al. The impact of 2011 ACGME duty hour restrictions on internal medicine resident workload and education. Adv in Health Sci Educ 20, 193–203 (2015). https://doi.org/10.1007/s10459-014-9525-5

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  • DOI: https://doi.org/10.1007/s10459-014-9525-5

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