ACGME Duty-Hour Restrictions Decrease Resident Operative Volume: A 5-Year Comparison at an ACGME-Accredited University General Surgery Residency

Abstract

We compared the operative experience of chief residents at the Michigan State University Integrated Residency Program in General Surgery before and after duty-hour restrictions mandated by the Accreditation Council for Graduate Medical Education. Conflicting evidence exists regarding the influence of duty-hour restrictions upon resident operative experience. Resident self-reported operative experience submitted to the Residency Review Committee (RRC) for Surgery was tabulated. To control for a possible overall decrease in surgical procedures, for example, a decrease in referrals to the institution, the departmental database of surgical billings that is maintained independently from resident operative experience data also was reviewed. An overall decrease of nearly 20% occurred in resident operative volume after promulgation of duty-hour restrictions. All residents met minimum RRC operative experience requirements. Over the same period, no decrease was found in the number surgical procedures performed by the department. Our data suggest that restriction of resident duty hours is associated with a significant decrease in operative experience.