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Study examines effect of resident duty hour reforms on general surgery patients

The JAMA Network Journals

An examination of the effect of resident duty hour reforms in 2011 finds no significant change in outcomes for general surgery patients, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

Ravi Rajaram, M.D., of the American College of Surgeons, Chicago, and colleagues conducted a study to determine if the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance.

The study examined general surgery patient outcomes two years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period.

In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. In adjusted analyses, the researchers found that the duty hour reform was not associated with a significant change in death or serious illness in either post-reform year 1 or post-reform year 2 or when both post-reform years were combined. There was also no association between duty hour reform and any other postoperative adverse outcome.

Average in-training examination scores did not significantly change from 2010 to 2013 for first-year residents, for residents from other postgraduate years, or for first-time examinees taking the written or oral board examinations during this period.

The authors write that the study findings could be interpreted in at least two ways. "First, there is no evidence of worsened patient care or resident education, and given assumed improvements to resident well-being, this could indicate that current policies should continue forward as they are. Conversely, the potential harm from poor continuity of care, increased handoffs, trainees feeling unprepared to practice, and concern regarding residents developing a shift-work mentality engendered by these policies could suggest that the duty hour reform may require significant revision or reconsideration. Although many of these concerns have not been substantiated by consistent evidence, they reflect the intense interest duty hour reform has generated from the clinical and educational community."

"The implications of these findings should be considered when evaluating the merit of the 2011 ACGME duty hour reform and revising related policies in the future."

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(doi:10.1001/jama.2014.15277; Available pre-embargo to the media at http://media.jamanetwork.com)

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