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Original Article |

Effects of Duty Hour Restrictions on Core Competencies, Education, Quality of Life, and Burnout Among General Surgery Interns

Ryan M. Antiel, MD, MA; Darcy A. Reed, MD, MPH; Kyle J. Van Arendonk, MD; Sean C. Wightman, MD; Daniel E. Hall, MD, MDiv, MHSc; John R. Porterfield, MD, MPH; Karen D. Horvath, MD; Kyla P. Terhune, MD; John L. Tarpley, MD; David R. Farley, MD
JAMA Surg. 2013;148(5):448-455. doi:10.1001/jamasurg.2013.1368.
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Objective To measure the implications of the new Accreditation Council for Graduate Medical Education duty hour regulations for education, well-being, and burnout.

Design Longitudinal study.

Setting Eleven university-based general surgery residency programs from July 2011 to May 2012.

Participants Two hundred thirteen surgical interns.

Main Outcome Measures Perceptions of the impact of the new duty hours on various aspects of surgical training, including the 6 Accreditation Council for Graduate Medical Education core competencies, were measured on 3-point scales. Quality of life, burnout, balance between personal and professional life, and career satisfaction were measured using validated instruments.

Results Half of all interns felt that the duty hour changes have decreased the coordination of patient care (53%), their ability to achieve continuity with hospitalized patients (70%), and their time spent in the operating room (57%). Less than half (44%) of interns believed that the new standards have decreased resident fatigue. In longitudinal analysis, residents' beliefs had significantly changed in 2 categories: less likely to believe that practice-based learning and improvement had improved and more likely to report no change to resident fatigue (P < .01, χ2 tests). The majority (82%) of residents reported a neutral or good overall quality of life. Compared with the normal US population, 50 interns (32%) were 0.5 SD less than the mean on the 8-item Short Form Health Survey mental quality of life score. Approximately one-third of interns demonstrated weekly symptoms of emotional exhaustion (28%) or depersonalization (28%) or reported that their personal-professional balance was either “very poor” or “not great” (32%). Although many interns (67%) reported that they daily or weekly reflect on their satisfaction from being a surgeon, 1 in 7 considered giving up their career as a surgeon on at least a weekly basis.

Conclusions The first cohort of surgical interns to train under the new regulations report decreased continuity with patients, coordination of patient care, and time spent in the operating room. Furthermore, suboptimal quality of life, burnout, and thoughts of giving up surgery were common, even under the new paradigm of reduced work hours.

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Figure. Percentage of 2011 surgical interns10 who believe that the new duty hour regulations would cause a decrease in a particular educational area compared with 2012 interns who believe that the changes have caused a decrease in that educational area. * P ≤ .01. C indicates interpersonal and communication skills; CHP, continuity with hospitalized patients; MK, medical knowledge; OE, overall education; P, professionalism; PBL, practice-based learning and improvement; PC, patient care; RF, resident fatigue; SBP, systems-based practice; SS, surgical skills; TF, time on floor; TO, time in operating room.

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