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Original Investigation | Pacific Coast Surgical Association

Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume:  A Multi-institutional Study

Samuel I. Schwartz, MD1,2; Joseph Galante, MD3; Amy Kaji, MD, PhD1,2; Matthew Dolich, MD4; David Easter, MD5; Marc L. Melcher, MD, PhD6; Kevin Patel, MD7; Mark E. Reeves, MD, PhD8; Ali Salim, MD9; Anthony J. Senagore, MD10; Danny M. Takanishi Jr, MD11; Christian de Virgilio, MD1
[+] Author Affiliations
1Department of Surgery, Harbor–University of California at Los Angeles Medical Center, Torrance
2Department of Emergency Medicine, Harbor–University of California at Los Angeles Medical Center, Torrance
3Department of Surgery, University of California at Davis, Sacramento
4University of California, Irvine
5University of California, San Diego
6Stanford University, Stanford, California
7Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
8Loma Linda University Medical Center, Loma Linda, California
9Cedars-Sinai Medical Center, Los Angeles, California
10Keck Medical Center, University of Southern California, Los Angeles
11University of Hawaii, Manoa
JAMA Surg. 2013;148(9):829-833. doi:10.1001/jamasurg.2013.2677.
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Importance  The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction.

Objective  To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience.

Design, Setting, and Participants  A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included.

Main Outcomes and Measures  Total, major, first-assistant, and defined-category case totals.

Results  As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases.

Conclusions and Relevance  The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

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Operative Volume

Intern operative volume before (2007-2011) and after (2011-2012) the duty-hour change.

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