Effect of the ACGME Duty Hours Restrictions on Surgical Residents and Faculty: A Systematic Review
Academic MedicinePublished 20 November 2010
Mohammad H. Jamal, Mathieu Rousseau, Waël C. Hanna, Suhail A.R. Doi, Sarkis Meterissian, Linda Snell
Citations111
SJR quartileQ1
SJR score1.45
SNIP2.03
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
The largest and most current review of the literature addressing the effect of the ACGME duty hours limitations on surgical training, finding that limitations had a positive effect on residents but a negative effect on surgical faculty.
Abstract
This is the largest and most current review of the literature addressing the effect of the ACGME duty hours limitations on surgical training. Limitations had a positive effect on residents but a negative effect on surgical faculty. Importantly, duty hours limitations did not adversely affect surgical residents' operating-room experience.
Keywords
Social SciencesMedicine
Research in Nursing & HealthWhatever happened to qualitative description?
11,924 Citations2000Margarete Sandelowski
The general view of descriptive research as a lower level form of inquiry has influenced researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description.
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.
The American Journal of SurgeryEffect of sleep deprivation on the performance of simulated laparoscopic surgical skill
304 Citations2003Brian J. Eastridge, Elizabeth C. Hamilton +6 more
Call-associated sleep deprivation and fatigue are associated with increased technical errors in the performance of simulated laparoscopic surgical skills in the MIST VR surgical simulator.
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
Archives of SurgeryEffect of the 80-Hour Workweek on Resident Burnout
210 Citations2004Dmitri V. Gelfand
Despite successful reductions in resident work hours, measures of burnout were not significantly affected and important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained.
Advances in Health Sciences EducationBest Evidence Medical Education
189 Citations2000Ronald M. Harden, Janet Grant +2 more
Best Evidence Medical Education is the implementation, by teachers in their practice, of methods and approaches to education based on the best evidence available, which involves a professional judgement by the teacher taking into account a number of factors — the QUESTS dimensions.
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.
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.
Current SurgeryEffect of Work-hour Reforms on Operative Case Volume of Surgical Residents
116 Citations2005Charles M. Ferguson, Katherine C. Kellogg +2 more
A careful but aggressive plan of work-hour reduction was devised for the residency of the authors' institution with the goal to decrease work hours while maintaining optimal patient care and resident education, including operative case volume.
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.
The American Journal of SurgeryImpact of the 80-hour work week on resident emergency operative experience
110 Citations2005Mark A. Feanny, Bradford G. Scott +2 more
The ACGME regulatory environment is adversely affecting the emergency operative experience of surgical residents and the need to develop alternative methods to augment the residents' operative experience is underscored.
SurgerySurgical residents' perceptions of the effects of the ACGME duty hour requirements 1 year after implementation
104 Citations2005Jennifer Irani, Michelle M. Mello +4 more
Most surgical residents do not believe that the ACGME duty hour requirements have had their intended effect of improving quality of care and are ambivalent about effects on the quality of their training, however, they report an improved quality of life, and most residents do support the requirements overall.
Current SurgeryThe 80-Hour Resident Workweek Does Not Adversely Affect Patient Outcomes or Resident Education
100 Citations2006Christian de Virgilio, Arezou Yaghoubian +3 more
The reorganization of the authors' general surgery residency program to comply with the duty hour restrictions was achieved within reasonable cost and the quality of surgical resident education, as measured by operative volumes, ABSITE scores, and written and oral board examination pass rates were likewise unchanged.
Journal of the American College of SurgeonsImplementation and Evaluation of a New Surgical Residency Model
96 Citations2007Joseph R. Schneider, John Coyle +3 more
Evaluation research results collected to study the impact of a reengineered residency program designed to preserve important educational activities while meeting duty-hour accreditation requirements show substantial improvements in residents' educational experience.
Journal of surgical educationThe Impact of Work Hour Restrictions on Surgical Resident Education
95 Citations2008Emily T. Durkin, R.J. McDonald +2 more
The effect of reduced work hours on resident standardized test scores and operative volume at an institution was determined and an unexpected consequence of work-hour restrictions may be an improvement in surgical resident education.
The American Journal of SurgeryJack Barney award: The effect of fatigue on cognitive and psychomotor skills of trauma residents and attending surgeons
92 Citations2008Jodi Gerdes, Kanav Kahol +3 more
Call-associated fatigue is associated with increased error rates in the cognitive skill domain, although less so in attending surgeons compared with their resident counterparts, as well as on psychomotor and cognitive skills.
Clinical Orthopaedics and Related ResearchEffect of Duty Hour Standards on Burnout among Orthopaedic Surgery Residents
87 Citations2006Robert L. Barrack, Linda S Miller +3 more
Journal of the American College of SurgeonsHas the 80-Hour Work Week Had an Impact on Voluntary Attrition in General Surgery Residency Programs?
82 Citations2005Thomas J. Leibrandt, Christopher M. Pezzi +3 more
Rates and patterns of attrition seem to have been unaffected by Accreditation Council for Graduate Medical Education work-hours limitations.
Journal of the American College of SurgeonsImpact of Work-Hour Restrictions on Residents’ Operative Volume on a Subspecialty Surgical Service
81 Citations2005Ariel U. Spencer, Daniel H. Teitelbaum
The 80-hour limit has had minimal impact on residents' operative experience, in case number and variety, and residents' perceptions of their educational experience.
The American Journal of SurgeryBrief communication of the Residency Review Committee-Surgery (RRC-S) on residents’ surgical volume in general surgery
81 Citations2005Kirby I. Bland, Doris A. Stoll +2 more
The data provided in the first year of evaluation since the implementation of the 80-hour work-week restriction policy suggest that there has been no significant change in the overall surgical experience for major procedures (per resident), nor has there been a negative impact on Chief Resident surgical experience.
The American SurgeonEffect of the 80-Hour Work Week on Cases Performed by General Surgery Residents
79 Citations2005Shannon T. McElearney, Alison R. Saalwachter +4 more
Operative training experience does not appear to be hindered by the 80-hour work week, and PGY5s did have statistically fewer cases after the work-hours restriction, which likely represented shifting of postcall afternoon cases to other residents.
The American Journal of SurgeryHas implementation of the 80-hour work week made a career in surgery more appealing to medical students?
77 Citations2005Mark Arnold, Anna F. Patterson +1 more
The new Accreditation Council for Graduate Medical Education (ACGME) regulation has had a positive impact on students' perceptions of the surgeon's lifestyle, but does not necessarily increase their interest in a surgical career.
The American Journal of SurgeryGeneral surgery resident attrition and the 80-hour workweek
70 Citations2007Christopher Everett, Stephen D. Helmer +2 more
Despite improvements in work hours and lifestyle during surgical training, residents migrate to specialties that are conducive to a more controllable lifestyle after experiencing surgery residency.
Obstetrics and GynecologyThe Effect of House Staff Working Hours on the Quality of Obstetric and Gynecologic Care
70 Citations2004Jennifer L. Bailit, May Hsieh Blanchard
Although problems in physician performance may be underreported, resident work-hour restrictions show minimal evidence of improvement in quality of care.
American Journal of Obstetrics and GynecologyImpact of work hour restrictions on resident case experience in an obstetrics and gynecology residency program
67 Citations2004May Hsieh Blanchard, Saeid B. Amini +1 more
Work hour restrictions have had impact on resident case experience in obstetrics and gynecology, with decreases in resident experience in total abdominal hysterectomy, procedures for genuine stress urinary incontinence, and hysteroscopy.
Current SurgeryBefore and after resident work hour limitations: An objective assessment of the well-being of surgical residents
64 Citations2005Thomas Stamp, Paula M. Termuhlen +5 more
Although a great deal of concern has existed about the impact of work hour limitations on surgery resident training, residents feel their training has not been affected significantly and work hour restrictions have had a positive impact on the lives of surgery residents outside of the hospital.
Current SurgeryThe 80-hour work week: Will we have less-experienced graduating surgeons?
62 Citations2004Benjamin T. Jarman, Marcus R. Miller +5 more
The goal was to measure the impact that work-hour restrictions have on operative volumes and to evaluate the potential benefit of a night rotation to minimize the number of "lost operations."
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.
The American SurgeonThe Effect of the 80-Hour Work Week on General Surgery Resident Operative Case Volume
52 Citations2006Julie Tran, Roger Lewis +1 more
The 80-hour work week did not adversely affect the operative experience of the categorical surgical residents despite significant reductions of in-house call.
Current SurgeryHas the 80-hour work week increased faculty hours?
48 Citations2004Emily R. Winslow, Lisa Berger +1 more
The majority of the faculty feels that both patient care and resident education have deteriorated, and faculty work hours have not increased in the 6 months after the institution of the 80-hour resident work week.
Current SurgeryMeeting the 80-hour work week requirement: What did we cut?
48 Citations2004Raphael S. Chung, Naveed Ahmed +1 more
Reducing work hours cannot be accomplished without reducing educational components, and unlike junior residents, senior residents felt less fulfilled with the new system and do not benefit in physical fatigue.
Annals of SurgeryMedical Students' Perceptions of Resident Teaching
45 Citations2005Aimee Elizabeth Brasher, Shahnaz Chowdhry +2 more
Journal of Bone and Joint SurgeryThe Impact of the Accreditation Council for Graduate Medical Education Work-Hour Regulations on the Surgical Experience of Orthopaedic Surgery Residents
43 Citations2007Alexander J. Pappas, David Teague
Although many aspects of surgical training may be affected by the new work-hour restrictions, the review of the operative experience of orthopaedic surgery residents at a single institution demonstrated no significant differences before and after the implementation of the eighty-hour workweek.
Clinical Orthopaedics and Related ResearchThe Effect of Work Hour Restrictions on the Education of Orthopaedic Surgery Residents
41 Citations2006Terrance D. Peabody
Overall, the respondents thought the duty hour restrictions had a negative impact on orthopaedic residency education but less so than in the previous survey, and were not of the opinion resident performance had improved as measured by perceptions of performance on standardized tests.
Journal of Bone and Joint SurgeryMeasuring the Attitudes and Impact of the Eighty-Hour Workweek Rules on Orthopaedic Surgery Residents
41 Citations2007Sharat K. Kusuma, Samir Mehta +5 more
Although residents report an improved quality of life as a result of these new rules, the attitude that the quality of training is diminished persists, and resident attitudes toward the work rules are mixed.
SurgeryPsychologic well-being of surgery residents after inception of the 80-hour workweek: A multi-institutional study
39 Citations2005Shahram Zare, Joseph A. Galanko +7 more
Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents and the perception of stress and academic performance remains unchanged.
Archives of SurgeryEffects of Resident Duty-Hours Restrictions on Surgical and Nonsurgical Teaching Faculty
37 Citations2007Kimberly A. Vanderveen
Surgeons reported a particularly negative effect from resident duty-hours reform, especially within the areas of job satisfaction, time for teaching, and workload, which will be critical to maintain and recruit teaching faculty.
The Journal of Trauma: Injury, Infection, and Critical CareLife after 80 Hours: The Impact of Resident Work Hours Mandates on Trauma and Emergency Experience and Work Effort for Senior Residents and Faculty
35 Citations2005Mark A. Malangoni, John J. Como +2 more
Evaluating the impact of work hours mandates on senior resident patient exposure and operating experience in trauma and emergency surgery and faculty work effort found a 50% reduction in senior resident call and a 19% decrease in their work hours with no significant change in trauma/emergency patient care exposure or operative case load.
The LaryngoscopeImpact of Duty Hour Limits on Resident Training in Otolaryngology
34 Citations2005Evan R. Reiter, Denise R. Wong
Implementation of Accreditation Council for Graduate Medical Education (ACGME) duty hour standards has had limited effects on resident training in otolaryngology.
The American SurgeonThe Effects of Restricted Work Hours on Clinical Training
33 Citations2006Raffy L. Karamanoukian, Joseph K. Ku +3 more
In this study, a majority of the respondents did believe that work-week restrictions significantly affected patient care and clinical exposure, but few respondents were willing to accept an additional year of training to compensate for the loss of this clinical exposure.
Journal of Cancer EducationImpact of the Recent Reduction in Working Hours (The 80 Hour Work Week) on Surgical Resident Cancer Education
32 Citations2005John T. Vetto, Debra Robbins
Overall, the recent reduction in work hours does not appear to have changed residents' experience with cancer patient care, although possible early reductions in attendance at cancer operations and tumor boards merits further study and possibly future schedule changes.
PubMedImpact of duty hour limitations on resident and student education in obstetrics and gynecology.
32 Citations2007Eve Espey, Tony Ogburn +1 more
Teachers should accommodate duty hour limitations in the context of excellence in student and resident education in obstetrics and student education.
Journal of Surgical ResearchThe 80-Hour Work Guidelines and Resident Survey Perceptions of Quality
29 Citations2006C. Katarina Biller, Anthony C. Antonacci +5 more
Mere work-hour reduction does not appear to improve patient care quality automatically nor to decrease the possibility for some types of error, and process interventions that specifically target trainee sign-out coverage constraints as part of a global reassessment will be important for future attempts to enhance quality hospital patient care.
The Journal of Maternal-Fetal & Neonatal MedicineThe 80-hour workweek restriction: How are OB/GYN resident procedure numbers affected?
25 Citations2006Amy C. Short, Stacey J. Rogers +4 more
The 80-hour workweek restriction resulted in similar total numbers of obstetrics and gynecology cases, although the total number of obstetric cases per resident declined after implementation.
Journal of the American College of SurgeonsEffect of the 80-Hour Work Week on Resident Case Coverage: Corrected Article
24 Citations2008Susanna Shin, Rebecca C. Britt +1 more
Journal of Bone and Joint SurgeryThe Impact of the Accreditation Council for Graduate Medical Education Work-Hour Regulations on the Surgical Experience of Orthopaedic Surgery Residents
24 Citations2007Alexander J. Pappas, David Teague
The American SurgeonAre Resident Work-Hour Limitations Beneficial to the Trauma Profession?
23 Citations2006Tara H. Abraham, Marilee Freitas +3 more
It is hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively.
OtolaryngologyImplementation of duty hour standards in otolaryngology‐head and neck surgery residency training
22 Citations2005Todd A. Kupferman, Tim S. Lian
According to the majority of otolaryngology-head and neck surgery program directors, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents.
The American SurgeonThree-Year Results of Mandated Work Hour Restrictions: Attending and Resident Perspectives and Effects in a Community Hospital
22 Citations2008Danny M. Vaughn, Christopher L. Stout +6 more
Attending staff and residents have deeply held opinions regarding the effects of work hour restrictions, reflecting a continuing dissatisfaction with providing patient care and educating residents under a set of requirements that solely addresses resident sleepiness and fatigue.
Journal of surgical educationEffect of the 30-Hour Work Limit on Resident Experience and Education
20 Citations2007Brent Izu, R. Michael Johnson +2 more
Evaluated occasions when the 30-hour work restriction could be extended to provide continuity of care and a better educational operative experience while maintaining weekly duty hours within the approved limit and identified occasions when this can be extended in certain cases.
World Journal of SurgeryCurrent Status and Future Perspective of General Surgical Trainees in the Netherlands
20 Citations2007Bas P. L. Wijnhoven, David I. Watson +1 more
Both male and female trainees expressed the wish to work an average of 52 hours per week as a consultant, and they want these hours to occur in 4.1 days of work per week.
Current SurgeryImpact of Resident Duty-Hour Reform on Faculty Clinical Productivity
18 Citations2005Mary E. Klingensmith, Emily R. Winslow +2 more
Faculty have preserved work hours and clinical productivity, despite a tendency to take on work previously done by residents, and this suggests that academic activities may have suffered.
The American Journal of SurgeryImpact of resident work-hour restrictions on trauma care
16 Citations2006Matthew C. Byrnes, Vincent C. Narciso +3 more
The ACGME-mandated work-hour restrictions have had a dramatic effect on resident and staff surgeons involved in the care of injured patients and resident education and appropriate methods of responding to these challenges must be developed.
The American SurgeonFactors Affecting Attrition in Graduate Surgical Education
14 Citations2007Som Kohanzadeh, Yukiharu Hayase +3 more
Significantly more residents who started a career in surgery after 2004 left to train in another specialty, and Strategies for better retention of matched residents are necessary to reverse this worrisome trend.
The Annals of Thoracic SurgeryImpact of Resident Duty Hour Standards on Cardiothoracic Residents and Program Directors
13 Citations2005Jacob DeLaRosa, Vinod H. Thourani +5 more
The impact of Resident Duty Hour Standards on Cardiothoracic Residents and http://ats.ctsnetjournals.org/cgi/content/full/80/5/1569 located on the World Wide Web at: The online version of this article, along with updated information and services, is.
American Journal of Obstetrics and GynecologyThe perceived impact of duty hour restrictions on the residency environment: A survey of residency program directors
12 Citations2006Francis S. Nuthalapaty, Alissa Carver +2 more
Variations in current opinions regarding the impact of residency duty hour restrictions reflect ongoing bias in those most influential to resident education.
Journal of Pediatric SurgeryPediatric surgery fellowship compliance to the 80-hour work week
12 Citations2006Alan P. Ladd
A minority of pediatric surgery fellows comply with ACGME guidelines, but a shift of patient care to fellows is perceived and Vigilance of duty hour tracking correlates to better compliance.
Journal of Pediatric SurgeryThe impact of the 80-hour workweek on pediatric surgical training: an Association of Pediatric Surgery Program Directors–sponsored study
12 Citations2005Marion C.W. Henry, Bonnie L. Silverman +1 more
Medical EducationThe impact of duty hour restrictions on teaching by surgical residents
11 Citations2005B. Price Kerfoot, Kate S Nabha +1 more
An ambulatory-care curriculum that emphasises longitudinal care of disease, special situations, and practice management, and web-based simulations of ambulatory care, which are called ‘Continuity of Care Online Simulations' (COCOS), to help fill this void.
Journal of Pediatric SurgeryPaediatric surgery: trends in UK surgical trainees' operative experience
7 Citations2006George Youngson, Stephen Adams +1 more
