The survey included more than 95 percent of the 3,700 residents participating in the FIRST Trial. The trial is the first national randomized study to compare surgical residency duty hour requirements to flexible policies.
Fifty-nine general surgery residency programs followed standard duty hour policies in the FIRST Trial, set by the Accreditation Council for Graduate Medical Education. Fifty-eight programs implemented a flexible policy that overlooked some ACGME rules on maximum shift lengths and mandatory time off between shifts. Both groups were capped at 80-hour workweeks over a four-week period.
The survey sought to discover whether the residents had varying views on patient safety, continuity of care, resident education and clinical training as well as resident well-being.
Journal of the American College of Surgeons published the survey findings.
Duty hours
• Of the respondents, 86 percent said they preferred flexible duty hour policies as opposed to standard duty hours, or did not have a preference.
Patient safety
• A greater majority of residents in the standard-hours group reported dissatisfaction with patient safety, compared to the flexible-hours group.
• Sixty-one percent of senior residents reported dissatisfaction with continuity of care in the standard-hours group, compared to 25.6 percent of those in the flexible-hours group.
• Interns operating under the standard-hours policy were forced to leave during an operation more frequently (17.9 percent), compared to those operating under flexible hours (6.9 percent).
Resident education
• More residents in the standard-hours group noted dissatisfaction with the quality of their residency education with each additional training year.
Resident well-being
• Those residents operating under flexible hours were more likely to report a negative effect on their well-being, rather than those who worked under the standard policy.
• While one-fourth of junior residents reported the flexible hours took away time for rest, only 16 percent of senior residents noted the same.
“We already know that flexible training hours do not harm patients and improve residents’ educational experience,” said David B. Hoyt, MD, executive director, American College of Surgeons. “The next step is for residency programs to achieve a proper balance between safely caring for patients and training residents to an optimal level, while considering the well-being of the resident physicians who provide that care.”
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