Resident Operative Experience in General Surgery, Plastic Surgery, and Urology 5 Years After Implementation of the ACGME Duty Hour Policy

• Published in: Annals of surgery Vol. 252; no. 2; pp. 383 - 389
• Main Authors: SIMIEN, Christopher, HOLT, Kathleen D, RICHTER, Thomas H, WHALEN, Thomas V, COBURN, Michael, HAVLIK, Robert J, MILLER, Rebecca S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-08-2010
• Subjects: Analysis of Variance; Biological and medical sciences; Chi-Square Distribution; Clinical Competence; General aspects; General Surgery - education; General Surgery - statistics & numerical data; Health participants; Humans; Internship and Residency; Linear Models; Medical sciences; Miscellaneous; Occupational medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery, Plastic - education; Surgery, Plastic - statistics & numerical data; United States; Urologic Surgical Procedures - education; Urologic Surgical Procedures - statistics & numerical data; Workload; United States; Human; Medicine; Work period; Health policy; Treatment; General surgery; Plastic surgery; Resident (student); Resident; Implementation; Public health; Urology
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0b013e3181e62299

Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place.
Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included.
Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs.
The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.