Residencies pinpoint work-hour hurdles

A survey reveals that the 24-hour call was the most difficult rule to implement, and the specialty facing the most compliance obstacles was surgery.

By Myrle Croasdale — Posted April 19, 2004

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Preliminary results of an Assn. of American Medical Colleges survey tell of a year of significant challenges within graduate medical education as it reshaped resident training to comply with the new 80-hour work week.

Sunny Yoder, AAMC director of health care affairs, presented these initial findings at the Accreditation Council for Graduate Medical Education conference in Chicago in March.

According to an Internet survey of resident program administrators, the specialty facing the biggest compliance hurdles was surgery, with 67.7% of 105 surgical programs represented in the survey saying they were greatly challenged by the new work hours. This was followed by neurological surgery, internal medicine, ob-gyn and thoracic surgery.

The survey was conducted Jan. 28 through Feb. 17 and 117 responses were collected.

Respondents said the most difficult rule to implement was the 24-hour call period, which also allows for six additional hours for patient transfers and educational activities.

Common obstacles were adjusting residents' schedules (reported by 56% of respondents), followed by uncooperative residents (31%), lack of funding to hire more staff (29%), difficulties managing transitions from one rotation to the next (27%) and uncooperative faculty (25%).

Respondents noted other barriers, such as getting residents to accurately record their hours in a timely fashion and collecting the data necessary to verify compliance.

Acceptance by faculty and program directors was an ongoing battle for some, who found they had to continually remind all involved of the rules.

Some programs noted positive effects, such as better organization of their residency programs overall, more streamlined patient care and improved resident morale.

Negative effects included a decrease in patient contact for residents, concern for patient safety as handoffs increased, a lack of continuity of care for hospitalized patients as well as those seen in clinics, and a decrease in faculty morale as their hours expanded.

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