A resident perspective on increasing duty-hour limitations

Abstract

We read the recent group of editorials regarding the quality of surgical resident training with great interest. 1 Polk H.C. Preserving the quality of training surgical residents. Am J Surg. 2011; 201: 719-720 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 2 Nauta R.J. The surgical residency and Accreditation Council for Graduate Medical Education reform: steep learning or sleep learning?. Am J Surg. 2011; 201: 715-718 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 3 Britt L.D. Resident duty-hour restrictions. Am J Surg. 2011; 201: 721-723 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar , 4 Reilly L.M. Training surgeons: have we reached the tipping point?. Am J Surg. 2011; 201: 724-725 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Accreditation Council for Graduate Medical Education duty-hour limitations imposed in 2003 were initiated primarily to achieve 2 goals: to improve resident quality of life and to protect patients from the perceived danger of care delivered by sleep-deprived physicians. New limitations that went into effect in July 2011 are even more restrictive, particularly for interns. In this era of evidence-based medicine, we should look to the evidence for support of the duty-hour limitations. The evidence, however, is lacking with regards to improvement in patient outcomes resulting from these limits. In fact, there has been no high-quality study showing improved quality of care in surgical patients because of duty-hour limitations. 5 Moalem J. Brewster L. James T. Position statement on further work hour restrictions: the views of current and recent trainees. Surgery. 2009; 146: 428-429 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Training surgeons: have we reached the tipping point?The American Journal of SurgeryVol. 201Issue 6PreviewThe consternation swirling around duty-hour restrictions for surgical residents has continued since the first national regulations were put in place by the Accreditation Council for Graduate Medical Education (ACGME) in 2003. Surgeons, surgical residents, and the bodies representing both groups are disconcerted by the lack of discipline-specific data supporting the need for the current (and new) regulations, as well as the lack of discipline-specific data showing that existing duty-hour regulations have improved any outcome variable relating to the safety of surgical patient care. Full-Text PDF The surgical residency and Accreditation Council for Graduate Medical Education reform: steep learning or sleep learning?The American Journal of SurgeryVol. 201Issue 6PreviewIn June of 2010, the Accreditation Council for Graduate Medical Education (ACGME) released its fourth message on duty-hour standards. Educational stakeholders—program directors, faculty, and trainees—were asked to review the standards and to offer suggestions to the ACGME Task Force. Full-Text PDF Preserving the quality of training surgical residentsThe American Journal of SurgeryVol. 201Issue 6PreviewThe one good aspect that I can see developing from the progressive diminution of clinical experience for trainees in surgical disciplines in the United States is the fact that our society generally, as reflected in the recent midterm election, has a tendency to flow in a pendulum manner. At some point, hopefully before too much damage is done, these tendencies about which Dr. Nauta writes so clearly will slow, then stop, and finally reverse themselves, to some degree. He surely is correct in his analysis of the current situation. Full-Text PDF Resident duty-hour restrictionsThe American Journal of SurgeryVol. 201Issue 6PreviewThe official responses to duty-hour limitations from organized surgery have been well documented and published. The surgical task force, assembled to address recommendations/proposals initially from the Institute of Medicine (IOM) and most recently from the Accreditation Council of Graduate Medical Education (ACGME), consisted of representation from essentially every surgical specialty. Appointed by Gerald B. Healy, MD, FACS, at that time, President of the American College of Surgeons, this surgical consortium (called the American College of Surgeons [ACS] Task Force on the Resident 80-Hour Work Week) represented approximately 250,000 surgeons in all the disciplines. Full-Text PDF