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General Surgery Residents’ Views on Work Hours Regulations

General Surgery Residents’ Views on Work Hours Regulations. Jay M. MacGregor, MD Robert P. Sticca, MD, FACS Department of Surgery University of North Dakota SMHS. Background. 2003: ACGME work hours regulations implemented 80 hours per week , averaged over a four-week period

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General Surgery Residents’ Views on Work Hours Regulations

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  1. General Surgery Residents’ Views on Work Hours Regulations Jay M. MacGregor, MD Robert P. Sticca, MD, FACS Department of Surgery University of North Dakota SMHS

  2. Background 2003: ACGME work hours regulations implemented • 80 hours per week, averaged over a four-week period • One day in seven free from all educational and clinical responsibilities • 10-hour time period provided between all daily duty periods and after in-house call • In-house call must occur no more frequently than every third night, averaged over a four-week period • Continuous on-site duty must not exceed 24 consecutive hours • with six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care 2008: IOM proposed further restrictions • limiting shift length to a maximum of 16 hours • requiring a minimum of one day off per week and five days off per month • counting moonlighting towards the 80 hour limit • call no more than every third day without averaging

  3. Debated • Physicians • Lawmakers • Patient advocates • Popular press • Resident Opinion lacking

  4. Current Study • Purpose: Obtain General Surgery residents’ views on work hours regulations and the ACGME survey • Design: 20 question survey emailed to all General Surgery Program Directors (May 2009) 9 questions –> work hours 9 questions –> ACGME survey 1 both, 1 demographic, comments • Study period (May to October, 2009) • Multiple reminders, pleas for participation • Internet Survey – surveymonkey.com

  5. Questions

  6. Results • Answers collected, analyzed (Nov 2009) • Aggregate • Level of training • Junior (PGY 1, 2) • Senior (PGY > 2) • Statistical analysis (openepi.com) • P value < 0.05, statistically significant

  7. Responses 965 –13.1 % of U.S. General Surgery Residents 961 –Completed entire survey (99.6%) Junior Residents: 441 Senior Residents: 520

  8. Results 37% (n=355) of residents did not feel the ACGME survey accurately evaluated the hours they worked in their residency programs 25% (n = 239) of residents indicated that they do not report all of their work hours Juniors = 22% Senior = 27% p = 0.032

  9. Results 16% (n = 151) admit to being instructed to report their work hours inaccurately 8% (n = 76) advised their co-residents or junior residents to report their work hours inaccurately 65% (n = 625) felt that residents in their program or other programs reported their work hours inaccurately

  10. Results 52% (n = 500) underreported work hours to stay and care for a patient or participate in surgery. 75% (n = 723) are not in favor of more stringent work hours Junior = 66% Senior = 83% p = <0.0000001 50% (n = 478) indicated that they would be less likely to pursue a surgical career if work hours restrictions made residency training longer - only 4% more likely to pursue surgery as a career in this situation

  11. Results 76% (n = 731) were aware of the new IOM recommendations 67% (n = 648) indicating that these IOM recommendations would make surgical residency training worse Junior = 56% Senior = 77% p = < .001 19% felt that these recommendations would make surgical residency better

  12. Discussion Many opinions regarding work hours. Limited information about how current surgical residents feel about existing and proposed changes. Those currently in surgical training may not be adequately represented in the debate over current and future work hours regulations.

  13. Discussion Majority of Surgical Residents have violated ACGME work hours rules to provide patient care and/or participate in a surgical case. Majority are aware of proposed changes by the IOM and feel such changes would be detrimental to their surgical training. Half of surgical residents would be less likely to pursue a career in General Surgery if further work hours restrictions coincides with an increase in the length of surgical training.

  14. Discussion There appears to be a discrepancy between current ACGME regulations and their actual implementation. Concerning that a significant percentage of surgical residents feel compelled to lie in order to participate in patient care under current guidelines.

  15. Thank You

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