Journal of General Internal Medicine

, Volume 22, Issue 7, pp 969–975 | Cite as

Resident Perceptions of the Impact of Work Hour Limitations

  • Grace A. Lin
  • David C. Beck
  • Anita L. Stewart
  • Jane M. Garbutt
Original Article



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.


work hour limitations residency survey factor analysis 



The authors wish to thank Steven Gregorich, PhD for his expert statistical advice and assistance, and Daniel Goodenberger, MD and Megan Wren, MD for their support of the project. This study was supported by a Mentors in Medicine grant from the Washington University School of Medicine and by a grant from the Partnerships for Quality Education. These data were presented at the Society of General Internal Medicine Annual Meeting on April 29, 2006.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Grace A. Lin
    • 1
  • David C. Beck
    • 2
  • Anita L. Stewart
    • 3
  • Jane M. Garbutt
    • 4
  1. 1.Division of General Internal MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Institute of Health & Aging University of California, San FranciscoSan FranciscoUSA
  4. 4.Division of General Medical SciencesWashington University School of MedicineSt. LouisUSA

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