Journal of General Internal Medicine

, Volume 21, Issue 9, pp 961–965

Internal medicine residents’ clinical and didactic experiences after work hour regulation

A survey of chief residents
  • Leora I. Horwitz
  • Harlan M. Krumholz
  • Stephen J. Huot
  • Michael L. Green
Original Articles


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.

Key Words

internship and residency workload education personnel staffing scheduling 


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  1. 1.
    The Patient and Physician Safety Act of 2001, H. R. 3236, 107th Congress, First Session, 2001.Google Scholar
  2. 2.
    Petition to the Occupational Safety and Health Organization requesting that limits be placed on hours worked by medical residents (HRG Publication #1570). Available at: Accessed March 6, 2006.Google Scholar
  3. 3.
    Accreditation Council for Graduate Medical Education. Common program requirements (resident duty hours). Available at: Accessed March 6, 2006.Google Scholar
  4. 4.
    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: Accessed March 6, 2006.Google Scholar
  5. 5.
    Accreditation Council for Graduate Medical Education. Statement of justification/impact for the final approval of common standards related to resident duty hours. Available at: Accessed March 6, 2006.Google Scholar
  6. 6.
    Wilson MC. In pursuit of optimal duty hours and resident experiences. J Gen Intern Med. 2004;19:97–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Fletcher KE, Underwood W III,Davis SQ, Mangrulkar RS, McMahon LF Jr,Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294:1088–100.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    New York Health Code, 10 NYCRR Sect 405.4 (1989).Google Scholar
  13. 13.
    Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse events. J Gen Intern Med. 2005;20:873–8.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Mendoza KA, Britt LD. Resident operative experience during the transition to work-hour reform. Arch Surg. 2005;140:137–45.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    Johnson T. Limitations on residents’ working hours at New York teaching hospitals: a status report. Acad Med. 2003;78:3–8.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Leora I. Horwitz
    • 1
    • 2
    • 3
  • Harlan M. Krumholz
    • 2
    • 3
  • Stephen J. Huot
    • 3
  • Michael L. Green
    • 3
  1. 1.VA Connecticut Healthcare SystemWest HavenUSA
  2. 2.Robert Wood Johnson Clinical ScholarYale University School of Medicine, IE-61 SHMNew Haven
  3. 3.Department of Internal MedicineYale University School of MedicineNew HavenUSA

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