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Invited Critique |

A Triumph of Hope Over Experience?  Comment on “Surgical Training, Duty-Hour Restrictions, and Implications for Meeting the Accreditation Council for Graduate Medical Education Core Competencies”

Mark L. Friedell, MD
Arch Surg. 2012;147(6):541. doi:10.1001/archsurg.2012.106.
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This study1 suggests that surgery interns are more idealistic and hopeful about the ACGME 2011 duty-hour restrictions than their program directors, who, for the most part, felt that the recommendations in the 2008 Institute of Medicine report were “incompatible with the realities of surgical training,” particularly for interns. Eliminating 2 important limitations of this study might have put the interns more “in sync” with the program directors. First, large university programs constituted 10 of the 11 programs surveyed. I suspect that those residents would be less concerned about duty-hour restrictions—because more of them subsequently chose to do fellowships and are less likely to go straight into general surgery practice—than those from nonuniversity or community programs. Second, preliminary interns constituted 42.5% of those surveyed, with no distinction made between those hoping to go into general surgery vs those on track for surgical subspecialties, anesthesia, or radiology. The general surgery–bound preliminary interns would most likely be more concerned about the restrictions than the others. In fact, the categorical interns surveyed were more concerned about continuity of care and less likely to believe that fatigue would decrease than preliminary residents. Regarding resident fatigue, many of the interns may not have realized that the loss of the “golden weekend” coupled with 6 straight days of 14-hour duty may be even more fatiguing than the work week before 2011. Interestingly, the differing perceptions of decreased continuity of care between interns and program directors barely met statistical significance.

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