A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic...

Full description

Saved in:

Bibliographic Details
Published in:	Annals of surgery Vol. 259; no. 6; p. 1041
Main Authors:	Ahmed, Najma, Devitt, Katharine S, Keshet, Itay, Spicer, Jonathan, Imrie, Kevin, Feldman, Liane, Cools-Lartigue, Jonathan, Kayssi, Ahmed, Lipsman, Nir, Elmi, Maryam, Kulkarni, Abhaya V, Parshuram, Chris, Mainprize, Todd, Warren, Richard J, Fata, Paola, Gorman, M Sean, Feinberg, Stan, Rutka, James
Format:	Journal Article
Language:	English
Published:	United States 01.06.2014
Subjects:	Education, Medical, Graduate - methods Educational Measurement General Surgery - education Humans Internship and Residency Patient Safety - standards Work Schedule Tolerance Workload - statistics & numerical data
ISSN:	1528-1140, 1528-1140
Online Access:	Get more information
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4
ISSN:	1528-1140 1528-1140
DOI:	10.1097/SLA.0000000000000595