Resident duty hours reform: Results of a national survey of the program directors and residents in neurosurgery training programs

Aaron Cohen-Gadol, David G. Piepgras, Satish Krishnamurthy, Richard D. Fessler

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.

Original languageEnglish (US)
Pages (from-to)398-402
Number of pages5
JournalNeurosurgery
Volume56
Issue number2
DOIs
StatePublished - Feb 2005
Externally publishedYes

Fingerprint

Neurosurgery
Graduate Medical Education
Accreditation
Confidence Intervals
Education
Guidelines
Continuity of Patient Care
Internship and Residency
Surveys and Questionnaires
Fatigue
Publications
Delivery of Health Care

Keywords

  • Accreditation Council for Graduate Medical Education
  • Program director
  • Residency
  • Resident
  • Work hours

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Resident duty hours reform : Results of a national survey of the program directors and residents in neurosurgery training programs. / Cohen-Gadol, Aaron; Piepgras, David G.; Krishnamurthy, Satish; Fessler, Richard D.

In: Neurosurgery, Vol. 56, No. 2, 02.2005, p. 398-402.

Research output: Contribution to journalArticle

Cohen-Gadol, Aaron ; Piepgras, David G. ; Krishnamurthy, Satish ; Fessler, Richard D. / Resident duty hours reform : Results of a national survey of the program directors and residents in neurosurgery training programs. In: Neurosurgery. 2005 ; Vol. 56, No. 2. pp. 398-402.
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abstract = "OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45{\%} and 23{\%} among the program directors and residents, respectively. Most programs offered one (37{\%}) or two (38{\%}) resident training positions per year. Although 92{\%} of programs had implemented the ACGME work hours requirements before or since July 2003, 8{\%} had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84{\%} (95{\%} confidence interval [CI], 64-94{\%}) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95{\%} CI, 89-96{\%}) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95{\%} CI, 46-63{\%}) of the residents and only 33{\%} (95{\%} CI, 20-50{\%}) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95{\%} CI, 22-37{\%}) of the residents and 17{\%} (95{\%} CI, 8-32{\%}) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46{\%} (95{\%} CI, 37-54{\%}) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21{\%} (95{\%} CI, 11-37{\%}) of program directors agreed. Forty-one percent (95{\%} CI, 33-49{\%}) of the residents and 74{\%} (95{\%} CI, 58-86{\%}) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61{\%} (95{\%} CI, 53-69{\%}) of the residents and 79{\%} (95{\%} CI, 63-89{\%}) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.",
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T1 - Resident duty hours reform

T2 - Results of a national survey of the program directors and residents in neurosurgery training programs

AU - Cohen-Gadol, Aaron

AU - Piepgras, David G.

AU - Krishnamurthy, Satish

AU - Fessler, Richard D.

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N2 - OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.

AB - OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.

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KW - Program director

KW - Residency

KW - Resident

KW - Work hours

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