A survey published in the June edition of Archives of Surgery reveals that many surgical interns believe that new duty-hour restrictions will have several consequences, including not being able to gain as much medical knowledge, having less time to develop surgical skills and overall educational experience, but also having less continuity with patients, time spent operating and coordination of care.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new resident duty-hour standards in July 2011, which included more supervision and working a maximum 16-hour shift for postgraduate year one residents.

Ryan M. Antiel, M.D., M.A., from Rochester’s Mayo Clinic in Minnesota and his team surveyed 215 eligible surgical interns from 11 general surgery residency programs from around the country, of which 179 completed the survey. In addition to the survey, the team also compared interns’ attitudes with a previously surveyed national sample of 134 surgery program directors.

The researchers state: “The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training.”

The results of the survey revealed that 80.3% of interns believed the new regulations would decrease continuity with patients, whilst 67.4% thought they would have less time spent operating and 57.6% felt that it reduced the coordination of patient care. 48% of interns thought it would decrease their acquisition of medical knowledge, whilst 52.8% thought they would have less time to develop surgical skills, and 51.1% believed their overall education would suffer through the time restriction.

The researchers comment:

“Although most interns and program directors agreed that the new changes will decrease coordination of patient care and residents’ acquisition of medical knowledge, a significantly larger proportion of program directors expressed these views compared with interns (87.3 percent vs. 57 percent and 76.9 percent vs. 48 percent).”

Even though 61.5% of interns felt that the changes would lower fatigue, the majority of program directors, i.e. 85.1% felt that the level of fatigue would remain the same under the new standards or even increase.

66.5% of interns believe that the quality and safety of patient care would either increase or remain unchanged because of the new duty-hour regulations, whilst 72.1% of interns believed that the residents’ ability to communicate with patients, families and other health professionals would either improve or remain unchanged.

Mark L. Friedell, M.D., of the University of Missouri-Kansas City, Mo., writes in an invited comment:

“This study suggests that surgery interns are more idealistic and hopeful about the ACGME [Accreditation Council for Graduate Medical Education] 2011 duty-hour restrictions than their program directors, who, for the most part, felt that the recommendation in the 2008 Institute of Medicine report were ‘incompatible with the realities of surgical training,’ particularly for interns.

Eliminating two important limitations of this study might have put the interns more ‘in sync’ with the program directors. The loss of surgical resident ‘ownership’ of the patient and the promulgation of a shift-work mentality are concerns of every surgical educator. Even when ignoring the limitations of this study, I believe it shows that the ‘line in the sand’ for the entire surgical community – residents and attendings – is no further resident duty-hour restrictions.”

Written By Petra Rattue