The Effects of Duty Hours Reform on Internal Medicine: Views from Different Levels of Practicing Medicine and Changes in Milestones Assessment Outcomes

Abstract

Purpose: We aim to elicit views from individuals at different levels of a medical hierarchy on the effects of the dury hour reform (DHR) on medical education and patient care. We also address the changes in the summative assessment of learning outcomes after the DHR. Methods: We conducted surveys of attending physicians from the Department of Internal Medicine, postgraduate year (PGY) residents, and clerks. Rates of prolonged hospitalization ＞ 30 days, 2-week readmissions, and revisits to the emergency room within 3 days of discharge before and after the DHR were checked. The subcompetence levels of reporting milestones of PGY residents before and after the DHR were compared. Results: More than half of the attending physicians were concerned about declines in the residents' development of skill (66.7%), knowledge (55.6%), and overall achievement (63%). However, none of the PGY residents considered the DHR to have a negative impact on learning. There were no significant declines in the perceptions of medical students on residents' teaching performance after the DHR or on the rates of readmission, emergency room revisits, and prolonged hospitalization. Significantly lower levels of milestones assessment scores in 17 out of 22 subcompetencies were noted after the DHR. Conclusions: A DHR has no significant impact on inpatient care and clerk education. Different from the perceptions of residents, both the assessments of milestones and the perceptions of attending physicians indicated a decline in learning outcomes after the DHR.