Original Article

Survey of Internal Medicine Physicians Trained in Three Different Eras: Reflections on Duty-Hour Reform

Authors: Carolyn M. Larsen, MD, Meltiady Issa, MD, Ivana T. Croghan, PhD, Tamara E. Buechler, MD, M. Caroline Burton, MD

Abstract

Objectives: To survey internal medicine physicians and residents who have completed residency in three different eras of medical training regarding their experiences during their intern year and their perceptions of duty-hour reform.

Methods: An online survey was administered to 268 residents, fellows, and staff physicians who had completed or were completing residency during one of three eras of training: before the 80-hour work week, after the 80-hour work week (instituted in 2003), and after the 16-hour limit on continuous shifts for interns (instituted in 2011). The survey assessed experiences during their intern year of residency and perceptions regarding resident duty-hour reform.

Results: The majority of respondents (n = 32; 54%) indicated that duty-hour restrictions would result in residents being less prepared for their future careers. In addition, 36% (n = 21) of respondents anticipated a decrease in the quality of patient care under the restricted duty hours. A total of 41% (n = 24) were undecided regarding the impact of duty-hour reform on patient care. Respondents reported time spent on independent study, research, and conference attendance did not increase following the institution of duty-hour restrictions.

Conclusions: Survey responses indicated that after 18 months of experience with the Accreditation Council for Graduate Medical Education duty-hour restrictions, physician opinions were mixed and a substantial number remain undecided regarding the impact of duty-hour restrictions on resident career preparedness and the quality of patient care.

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References

1. Nasca TJ, Day SH, Amis ES Jr, et al. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010;363:e3.
 
2. Mazotti LA, Vidyarthi AR, Wachter RM, et al. Impact of duty-hour restriction on resident inpatient teaching. J Hosp Med 2009;4:476-480.
 
3. Kashner TM, Henley SS, Golden RM, et al. Studying the effects of ACGME duty hours limits on resident satisfaction: results from VA learners’ perceptions survey. Acad Med 2010;85:1130-1139.
 
4. Parthasarathy S, Hettiger K, Budhiraja R, et al. Sleep and well-being of ICU house staff. Chest 2007;131:1685-1693.
 
5. Szymczak JE, Brooks JV, Volpp KG, et al. To leave or to lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified? Milbank Q 2010;88:350-381.
 
6. Shea JA, Weissman A, McKinney S, et al. Internal medicine trainees’ views of training adequacy and duty hours restrictions in 2009. Acad Med 2012;87:889-894.
 
7. Shea JA, Willett LL, Borman KR, et al. Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors. Acad Med 2012;87:895-903.
 
8. Afessa B, Kennedy CC, Klarich KW, et al. Introduction of a 14-hour work shift model for housestaff in the medical ICU. Chest 2005;128:3910-3915.
 
9. McCoy CP, Halvorsen AJ, Loftus CG, et al. Effect of 16-hour duty periods on patient care and resident education. Mayo Clin Proc 2011;86:192-196.
 
10. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377-381.
 
11. Drolet BC, Christopher DA, Fischer SA. Residents’ response to duty-hour regulations--a follow-up national survey. N Engl J Med 2012;366:e35.
 
12. Theobald CN, Stover DG, Choma NN, et al. The effect of reducing maximum shift lengths to 16 hours on internal medicine interns’ educational opportunities. Acad Med 2013;88:512-518.
 
13. Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med 2013;173:649-655.
 
14. Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med 2013;173:657-662.