Duty Hour Recommendations and Implications for Meeting the ACGME Core Competencies: Views of Residency Directors
Mayo Clinic ProceedingsPublished 10 February 2011Open access
Ryan M. Antiel, Scott M. Thompson, Frederic W. Hafferty, Katherine M. James, Jon C. Tilburt, Michael P. Bannon
Citations95
SJR quartileQ1
SJR score2.00
SNIP2.28
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.
Abstract
Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.
Keywords
Medicine
Journal of Biomedical InformaticsResearch electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support
51,662 Citations2008Paul A. Harris, Robert Taylor +4 more
Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data Capture tools to support clinical and translational research.
JAMAAssociation of Resident Fatigue and Distress With Perceived Medical Errors
964 Citations2009Colin P. West
Higher levels of fatigue and distress are independently associated with self-perceived medical errors among internal medicine residents, and sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression.
New England Journal of MedicineEffect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures
920 Citations2004Steven W. Lockley, John Cronin +10 more
Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.
New England Journal of MedicineThe New Recommendations on Duty Hours from the ACGME Task Force
548 Citations2010Thomas J. Nasca, Susan Day +1 more
Proposed modifications in the current requirements for medical residency training programs, including in the limits on resident hours, are explained and input on the new requirements is invited.
JAMANew Requirements for Resident Duty Hours
520 Citations2002Ingrid Philibert
A systematic review of the effectiveness of critical appraisal skills training for clinicians and the impact of an evidence-based medicine curriculum based on adult learning theory on students' reading habits and knowledge is presented.
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety
486 Citations2009Cheryl Ulmer, Dianne Miller Wolman +1 more
New England Journal of MedicineThe Libby Zion Case
397 Citations1988David A. Asch, Ruth M. Parker
The political and social pressures that urged the adoption of work shifts in the medical profession and a variety of forces from inside and outside the profession gave it support are examined.
Annals of SurgeryThe Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons
397 Citations2006Matthew M. Hutter, Katherine C. Kellogg +3 more
Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.
Academic MedicineMeasurement of the General Competencies of the Accreditation Council for Graduate Medical Education: A Systematic Review
359 Citations2009Stephen J. Lurie, Christopher J. Mooney +1 more
The peer-reviewed literature provides no evidence that current measurement tools can assess the competencies independently of one another, and the authors recommend using the Competencies to guide and coordinate specific evaluation efforts, rather than attempting to develop instruments to measure the competency directly.
Archives of Internal MedicineBurnout and Internal Medicine Resident Work-Hour Restrictions
344 Citations2005Ravi Gopal, Jeffrey J. Glasheen +2 more
Reducing hours may be the first step to reduce burnout but may also affect education and quality of care.
Academic MedicineA review of studies concerning effects of sleep deprivation and fatigue on residentsʼ performance
343 Citations1991J S Samkoff, C H Jacques
The data presently available suggest that sleep-deprived or fatigued house officers can compensate for sleep loss in crises or other novel situations, however, sleep- Deprived residents may be more prone to errors on routine, repetitive tasks and tasks that require sustained vigilance, which form a substantial portion of residents' workload.
JAMAEffects of Work Hour Reduction on Residents’ Lives
328 Citations2005Kathlyn E. Fletcher, Willie Underwood +4 more
Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments.
JAMAMortality Among Hospitalized Medicare Beneficiaries in the First 2 Years Following ACGME Resident Duty Hour Reform
323 Citations2007Kevin G. Volpp, Amy K. Rosen +7 more
The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation.
Archives of Internal MedicineTransfers of Patient Care Between House Staff on Internal Medicine Wards
293 Citations2006Leora I. Horwitz, Harlan M. Krumholz +2 more
Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.
Journal of the American College of SurgeonsEffects of Limited Work Hours on Surgical Training
285 Citations2002Catherine B. Barden, Michelle C. Specht +3 more
Reduction in resident work hours has salutary effects on perception of quality of life and basic education for surgical residents, but these benefits may come at the expense of patient care, particularly continuity of care.
Journal of the American College of SurgeonsCumulative Operative Experience Is Decreasing During General Surgery Residency: A Worrisome Trend for Surgical Trainees?
244 Citations2008John C. Kairys, Kandace P. McGuire +2 more
JAMAMortality Among Patients in VA Hospitals in the First 2 Years Following ACGME Resident Duty Hour Reform
226 Citations2007Kevin G. Volpp, Amy K. Rosen +7 more
Annals of Internal MedicineSystematic Review: Effects of Resident Work Hours on Patient Safety
224 Citations2004Kathlyn E. Fletcher, Steven Q. Davis +4 more
A systematic review of the literature examining the relationship between limiting resident work hours and patient safety will help inform policymakers and guide policymakers, program directors, and others who are involved in educating residents.
Journal of Vascular SurgeryMortality Among Patients in VA Hospitals in the First 2 Years Following ACGME Resident Duty Hour Reform
223 Citations2008Kevin G. Volpp, Amy K. Rosen +1 more
The ACGME duty hour reform was associated with significant relative improvement in mortality for patients with 4 common medical conditions in more teaching-intensive VA hospitals in postreform year 2.
PEDIATRICSEffects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety
192 Citations2008Christopher P. Landrigan, Amy M. Fahrenkopf +8 more
Although fewer residents were burned out, rates of medication errors, resident depression, and resident injuries and educational ratings did not improve after implementation of the duty hour standards.
New England Journal of MedicineThe Debate over Residents' Work Hours
190 Citations2002Robert Steinbrook
The system of training resident physicians in the United States is about to undergo substantial changes, and more — but not all — residents will be limited to 80 hours of work per week, averaged over a four-week period.
Annals of Internal MedicineChanges in Hospital Mortality Associated with Residency Work-Hour Regulations
175 Citations2007Kanaka Shetty, Jayanta Bhattacharya
Limiting residents' work hours was associated with lower in-hospital mortality rates for medical patients in teaching hospitals, and this finding suggested that duty-hours caps improve patient outcomes, but the sample size was too small to show effects on mortality.
The American Journal of SurgeryEffect of the 80-hour work week on resident operative experience in general surgery
162 Citations2007Arthur M. Carlin, Enej Gasevic +1 more
The mandated work-hour guidelines have negatively impacted the operative experience of general surgery residents, especially at the junior level, and despite implementing modifications designed to optimize resident operative experience, surgical training programs may require further adaptations.
Chronobiology InternationalMeta-Analysis of the Relationship Between Total Sleep Deprivation and Performance
158 Citations1992Meni Koslowsky, Harvey Babkoff
The correlations were found to be highest for TSD of greater than or equal to 45 h, speed rather than accuracy measures of performance, and work-paced rather than self-paced tasks, consistent with the "lapse hypothesis" that posits microsleeps during long hours of sleep deprivation.
Journal of surgical educationACGME Duty-Hour Restrictions Decrease Resident Operative Volume: A 5-Year Comparison at an ACGME-Accredited University General Surgery Residency
139 Citations2007Amir Damadi, Alan T. Davis +2 more
Compared to chief residents at the Michigan State University Integrated Residency Program in General Surgery before and after duty-hour restrictions mandated by the Accreditation Council for Graduate Medical Education, the data suggest that restriction of resident duty hours is associated with a significant decrease in operative experience.
Annals of Internal MedicineThe Effects of On-Duty Napping on Intern Sleep Time and Fatigue
139 Citations2006Vineet M. Arora, Carrie Dunphy +4 more
The provision of a nap during a 30-hour shift would increase sleep and decrease fatigue among residents and be an effective alternative to limits on total shift duration.
Academic PsychiatryComparison of Burnout Among Medical Residents Before and After the Implementation of Work Hours Limits
132 Citations2006Shahm Martini, Cynthia L. Arfken +1 more
Implementing work hour limits appeared to reduce burnout prevalence among residents after implementation of workhour limits compared with the rates prior to the implementation period.
New England Journal of MedicineCost Implications of Reduced Work Hours and Workloads for Resident Physicians
130 Citations2009Teryl K. Nuckols, Jay Bhattacharya +3 more
Implementing the four IOM recommendations would be costly, and their effectiveness is unknown, but if highly effective they could prevent patient harm at reduced or no cost from the societal perspective, however, net costs to teaching hospitals would remain high.
NeurosurgeryResident Duty Hours Reform: Results of a National Survey of the Program Directors and Residents in Neurosurgery Training Programs
114 Citations2005Aaron Cohen‐Gadol, David G. Piepgras +2 more
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.
PubMedObjective assessment of sleep and alertness in medical house staff and the impact of protected time for sleep.
90 Citations1996Richardson Gs, Wyatt Jk +5 more
Clinical Orthopaedics and Related ResearchEffect of Duty Hour Standards on Burnout among Orthopaedic Surgery Residents
87 Citations2006Robert L. Barrack, Linda S Miller +3 more
New England Journal of MedicineAn Elusive Balance — Residents' Work Hours and the Continuity of Care
84 Citations2007Susan Okie
Medical CareEffects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients
80 Citations2009Amy K. Rosen, Susan Loveland +8 more
Duty hour reform had no systematic impact on PSI rates, and in the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.
New England Journal of MedicineACGME Duty-Hour Recommendations — A National Survey of Residency Program Directors
80 Citations2010Ryan M. Antiel, Scott M. Thompson +6 more
Proposed new recommendations represent an attempt to address elements of the 2003 ACGME standards that generated "excellent and safe patient care" standards.
SurgeryResident perceptions of the impact of work-hour restrictions on health care delivery and surgical education: Time for transformational change
72 Citations2004Kara Kort, Lucio Pavone +4 more
The 80-hour workweek has the potential to have adverse effects on patient care despite improving the level of fatigue at work, and reengineering the surgical residencies will be needed to take full advantage of the restricted work hours.
Current SurgeryA 360° evaluation of a night-float system for general surgery: A response to mandated work-hours reduction
65 Citations2004Michael J. Goldstein, Eugene S. Kim +2 more
The institution of a specialized NF or CCS for in-house coverage of general surgical services in a large metropolitan university hospital has had initial success in meeting the mandated changes in resident work hours.
PubMedSleep deprivation and house staff performance. Update 1984-1991.
59 Citations1992Ling Leung, Cassandra Becker
All studies since 1990 support the hypothesis that sleep deprivation significantly impairs performance, and most studies support the impairment of physician mood with increasing sleep deprivation.
The American Journal of MedicineImpact of Duty Hours Restrictions on Quality of Care and Clinical Outcomes
57 Citations2007Jignesh Bhavsar, Daniel Montgomery +8 more
Implementation of the Accreditation Council for Graduate Medical Education residency duty-hours restrictions on an academic inpatient cardiology service was associated with improved quality of care and efficiency in patients admitted with acute coronary syndrome, and improved efficiency did not adversely impact patient outcomes, including mortality.
Academic MedicinePerspective: The ACGME Toolbox: Half Empty or Half Full?
55 Citations2010Michael L. Green, Eric S. Holmboe
The authors argue that the problem is not the lack of adequate evaluation instruments but, rather, the inconsistent use and interpretation of such instruments by unskilled faculty and urge the graduate medical education community to invest in training for faculty evaluators rather than waiting for new instruments.
Plastic & Reconstructive SurgeryThe Effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on Plastic Surgery Resident Education and Patient Care: An Outcomes Study
52 Citations2004C. Bob Basu, Li-Mei Chen +2 more
The current findings suggest that adherence to this policy improves patient care on multiple levels, and this work represents the first empiric study investigating the effect of duty hours reduction on plastic surgery training and education.
Critical Care MedicineEffect of work-hours regulations on intensive care unit mortality in United States teaching hospitals*
49 Citations2009Meeta Prasad, Theodore J. Iwashyna +5 more
There was a decrease in in-hospital mortality in intensive care unit patients during the years of observation, and this decrease was not associated with hospital teaching status, suggesting no net positive or negative association of the resident work-hours regulations with a major patient-centered outcome.
Academic MedicineResidents?? Perceptions of the Effects of Work Hour Limitations at a Large Teaching Hospital
47 Citations2006Grace A. Lin, David Beck +1 more
The findings suggest that imposing rigid work hour restrictions has significant consequences for patient Care and medical education and that the most effective ways to balance work hour limitations with the demands of patient care and necessary educational components to train competent physicians have yet to be identified.
PubMedImpact of the Libby Zion case on graduate medical education in internal medicine.
46 Citations1998Jeffrey M. Brensilver, Lynne T. Smith +1 more
In this historical analysis, a substantial augmentation of the number of trainees is reviewed: the need to maintain adequate inpatient staffing and in consideration of the reimbursement formulae and financial climate of New York State conspiring to promote substantial residency program expansion.
PubMedThe effect of resident work hour regulations on orthopaedic surgical education.
44 Citations2007Brian A Weatherby, Joseph N. Rudd +3 more
This study shows that residents who have begun training post-80-hour work week will do fewer procedures, which may result in a decreased level of skill, or it may shift operative experience to the senior resident years, prolonging the learning curve.
BMC Medical EducationResidents' perceptions of a night float system
43 Citations2009Harish Jasti, Barbara H. Hanusa +3 more
Overall, the residents felt more rested during their call months and strongly supported the 80-hour workweek requirement and felt that the overall quality of patient care was improved by a NF system.
JAMABuilding Physician Work Hour Regulations From First Principles and Best Evidence
28 Citations2008Kevin G. Volpp
Journal of Graduate Medical EducationSharpening the Focus on Systems-Based Practice
28 Citations2009Paul B. Batalden, David C. Leach
The Competency Advisory Committee was established and, with the help of ACGME staff in 3 meetings over the course of several months, gathered and reviewed the literature on physician competency, and settled on the 6 general competencies that are now widely known and used.
New England Journal of MedicineResidents' Duty Hours and Professionalism
25 Citations2009John D. Rybock
To the Editor: The Accreditation Council for Graduate Medical Education (ACGME) is currently reevaluating its 2003 rules regarding duty hours, in light of the recent recommendations from the Institute of Medicine (IOM) regarding additional limitations.
Current SurgeryResidency reform: Anticipated effects of ACGME guidelines on general surgery and internal medicine residency programs
23 Citations2005Jayme D. Lieberman, Judith A. Olenwine +2 more
Program directors anticipate improved resident safety and well-being, however, education, continuity of care, and board certification success are not expected to improve and increased cost to institutions is anticipated.
Southern Medical JournalChanges in Residentsʼ Attitudes in Response to Residency Program Modifications: A Prospective Study
18 Citations1992Charles B. Seelig
It is demonstrated that residents' attitudes can be objectively measured, and that residents accurately perceive and respond to program modifications, and in particular, the introduction of a night float resulted in markedly improved attitudes regarding time demands.
Journal of General Internal MedicineBeyond night float?
15 Citations1995Mark Rosenberg, Diana McNulty
Evaluation revealed that PMCF was perceived to ensure quality patient care to a greater degree than wasNF, to better facilitate resident education than was NF, and to have a less negative impact on personal lives than was EFNC.
Academic Pediatrics2. Educational Implications and Sleep and Fatigue Implications of the 2008 Proposed Work Hour Regulations: Pilot Studies
1 Citations2010Katherine A. Auger, Kira Sieplinga +2 more