Study: Resident education strong despite hour limits

Fears that residents might get more rest but less education when work-hour limits took effect in July 2003 don't appear to have come true, according to a collection of new studies.

Researchers who surveyed medical residents before the average resident workweek was capped at 80 hours and a year after the limits discovered small but significant decreases in educational opportunities. But residents continued to consider themselves clinically competent, according to "The Educational Impact of ACGME Limits on Resident and Fellow Duty Hours: A Pre-Post Survey Study" in December 2006 Academic Medicine.

"We wanted to look quickly for the possibility of a decrement in education," said Debra Weinstein, MD, a co-author of the study and vice president of graduate medical education for Partners Healthcare in Boston. "Fortunately, we didn't find that."

Individual specialties have studied work-hour reform effects, but these studies are the first to look at the issue across disciplines. Researchers queried residents from 76 programs at two large Boston teaching hospitals. They found that residents:

• Expressed that they were slightly less happy with their overall educational experience. In 2003, they found that 97.1% of residents in programs that saw a sharp reduction in hours said their overall satisfaction with their education was good or excellent, compared with 95.7% in 2004.
• Reported fewer bedside learning opportunities with faculty and less time for patient care after their hours were reduced.
• Discovered that scut work still took up a third of their time.
• Received the same number of important clinical experiences as before.

Another study in the December 2006 Academic Medicine, "Internal Medicine and General Surgery Residents' Attitudes about the ACGME Duty Hours Regulations: A Multicenter Study," had similar findings. Medical and surgical residents from five sites across the country reported that bedside teaching and opportunities for mentoring by faculty had decreased but that the overall quality of physicians trained had not suffered.

David Longnecker, MD, director of the division of health care affairs at the Assn. of American Medical Colleges, said these two studies, along with others featured in December 2006 Academic Medicine, highlight areas of resident training that need improvement and say the new work hours aren't creating irreparable damage.

He said programs continue to improve teaching opportunities for residents in the given time constraints. But there is no evidence that residents' knowledge base, skill sets, ability to manage disease or do surgery has been eroded, Dr. Longnecker said.

But Dr. Weinstein said residents' attitudes about shorter work hours could change. "This first cut seems to indicate residents felt they were still prepared based on the education they were getting, but that's after one year of the new system," she said.

Over the years of a resident's career, small reductions in education time could add up to something significant, she said. The end result, she added, could be that residents may not feel as satisfied as they do now.