Defining the Duty Hour for Surgical Trainees

Abstract

Being mindful of duty hours has become an integral part of surgical training. Violations can lead to disciplinary action by the American Council for Graduate Medical Education (ACGME), including probation or even withdrawal of accreditation. It is therefore crucial to ensure these hours are accurately reported. However, as these are often self-reported by the resident, what counts as a duty hour is at the discretion of the reporter. The goal of this study is to identify what trainees and faculty include in their definitions of a duty hour. We hypothesized that there would be discrepancies in faculty versus trainee definitions of the duty hour, and that there remains an unclear understanding of which nonclinical activities contribute to surgical trainee duty hours. An anonymous, voluntary survey was conducted at a single institution. The survey contained 14 scenarios, and participants answered either "yes" or "no" as to if they believed the scenario should be counted within duty hour reporting. Analysis of the results included evaluating overall responses to determine which scenarios were more controversial, as well as chi square analysis comparing trainee (residents and fellows) versus faculty responses to each scenario. This survey was performed within the Department of Surgery at the University of Texas Southwestern Medical Center, a large academic institution in Dallas, TX. There were 91 total faculty and trainee responses to the voluntary survey within the General Surgery Department and associated subspecialties, including 50 residents (54.9%), 4 clinical fellows (4.4%) and 37 faculty (40.7%). When analyzing total responses, the most controversial scenarios were taking a short period of home call (50.6% of all respondents included this as a duty hour), making a presentation for resident education (48.4%), making a presentation related to patient care (57.1%), and making a monthly call schedule (44.0%). The least controversial topic was transit to and from work (91.2% of all respondents did not include this as a duty hour). Additionally, there were statistically significant differences between trainee and faculty perceptions when it came to attending departmental curricula (96.2% trainees included as a duty hour v 81.6% faculty, p =0.02), participating in nonmandatory journal club (5.7% trainees v 23.7% faculty, p =0.01), and attending mentorship meetings (30.2% trainees v 52.6% faculty, p =0.03). There is no consensus as to what nonclinical activities formally count towards a duty hour. There are also significant differences identified between faculty and trainee definitions, which could have implications for duty hour reporting and ACGME violations. Further research is required to obtain a clearer picture of the surgical opinion on defining the duty hour, and hopefully this will reduce duty hour violations and better optimize surgical trainee education.