Duty-hour restrictions worry surgical interns

By Sarah Guy

Surgical interns in the USA fear that resident duty-hour standards implemented in 2011 by the Accreditation Council for Graduate Medical Education (ACGME) will have a significant negative impact on their training and patient care, show study results.

The standards include increased supervision and a 16-hour shift maximum for postgraduate year one residents, explain the study authors in the Archives of Surgery.

Interestingly, the opinions of interns surveyed were "markedly more optimistic" than those of surgical program directors, note David Farley (Mayo Clinic, Rochester, Minnesota, USA) and colleagues.

Directors were significantly more likely than interns to say that the changes would decrease coordination of patient care and acquisition of interns' medical knowledge, and overwhelmingly believed that their fatigue levels would remain unchanged.

"If surgical residents and educators do not believe in these policies, they may lead to discontent, disengagement, and dishonesty in reporting hours," write Farley and co-workers.

The team surveyed 179 first-year surgical residents (interns) regarding the implications of the ACGME standards and compared their views with those of 134 surgery program directors.

The majority of interns (80.3%) believed that the new duty-hour regulations will decrease their ability to achieve continuity with hospitalized patients and around half (a respective 57.6% and 48.0%) believed the changes would decrease coordination of patient care and acquisition of medical knowledge.

However, in significant contrast to program directors, the majority of interns also believed there would be an increase, or at least no change, in quality and safety of patient care (66.5%), residents' ability to communicate effectively with patients, families, and other health professionals (72.1%), and residents' investigation and self-evaluation of their own patient care (74.4%).

Over half of interns had concerns that the duty-hours would reduce their time spent in the operating room, at 67.4%, and 52.8% believed their development of surgical skills and time spent with patients on the hospital floor would decrease.

A total of 61.5% of interns believed that the ACGME standards would decrease resident fatigue overall, while program directors believed the opposite; 85.1% believed that fatigue would remain unchanged or actually increase.

This difference could be a result of directors' understanding that fatigue is influenced by more than total numbers of hours worked, remark Farley et al. Work will be "compressed into shorter periods thus increasing work intensity and resident stress," they note.

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