Abstract
BackgroundResidents are stakeholders in the debate surrounding duty hour restrictions, yet few studies have assessed their perspective on their programs’ efforts to comply with them.ObjectivesThis paper explores learners’ perceptions of the attributes of their programs in relation to duty hour compliance, and looks for evidence whether residents view duty hour limits as important to patient safety.MethodsA grounded-theory framework was used to analyze learners’ comments about programs’ compliance with US duty hour limits. Data were collected by ACGME in 2011, using resident consensus lists of program strengths and opportunities for improvement generated prior to accreditation site visits. The data set for this analysis encompasses 112 core and 69 subspecialty programs where these lists mentioned duty hours.ResultsThe analysis compared programs where residents viewed duty hour compliance as a strength, and programs where it was identified as an opportunity for improvement. Programs in the first group were characterized by clinical efficiency, responsiveness to problems, and a collegial environment that contributed to residents’ ability to meet clinical and learning goals within the restrictions. These attributes were lacking in the second group, and residents also commented on onerous duty hour reporting. Learners did not associate duty hour compliance with patient safety, and the few comments in this area centred almost exclusively on the presence or absence of supervision when junior residents first assumed clinical duties.ConclusionThe findings have practical implications for programs that wish to enhance their learning and patient care environment, and suggest areas for future research.
Highlights
Residents are stakeholders in the debate surrounding duty hour restrictions, yet few studies have assessed their perspective on their programs’ efforts to comply with them
Concerns about work hours and patient safety permeated the 2008 Institute of Medicine (IOM) report, and this study looks for evidence as to whether residents view duty hour limits as important to patient safety
To produce the data set for this study, site visitors transmitted the consensus lists received from the residents to an Accreditation Council for Graduate Medical Education (ACGME) staff member (JE), who removed identifiers and sorted the data
Summary
Residents are stakeholders in the debate surrounding duty hour restrictions, yet few studies have assessed their perspective on their programs’ efforts to comply with them. Postgraduate medical education prepares physicians for practice in a clinical specialty [1]. In this phase of training, young physicians – often for the first time – are exposed to the demands of real-life practice, including long work hours [2,3]. The IOM report did not implicate resident physicians or their long work hours, it generated debate in the health care community and the media about the safety and quality of care in US hospitals. In 2003 the Accreditation Council for Graduate Medical Education (ACGME), which accredits postgraduate medical education in the United States, instituted common duty hour limits for all accredited specialties, including a weekly limit of 80 hours, one day off in seven, and in-house call no more frequently than every third night [7]
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