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Surgical Residents' Perceptions of 2011 Accreditation Council for Graduate Medical Education Duty Hour Regulations

Brian C. Drolet, MD; Suma Sangisetty, MD; Thomas F. Tracy, MD; William G. Cioffi, MD
JAMA Surg. 2013;148(5):427-433. doi:10.1001/jamasurg.2013.169.
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Importance In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.

Objective To examine surgical residents' views of the 2011 ACGME Common Program requirements after implementation in July 2011.

Design A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.

Setting ACGME-accredited teaching hospitals in the United States and US territories.

Participants The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.

Main Outcomes and Measures Residents' perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.

Results A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).

Conclusions and Relevance A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions—improved education, patient care, and quality of life—have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.

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Figures

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Figure. This graph of comparative responses demonstrates differences between surgical and nonsurgical residents in the study. Each question asked is followed by an answer (eg, Disapprove) and the percentage of the respondents providing that answer. Surgical residents generally have more negative perspectives of the 2011 Accreditation Council for Graduate Medical Education Common Program requirements and their effects on safety, education, and quality of life.

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