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How Surgical Faculty and Residents Assess the First Year of the ACGME Duty-Hour Restrictions Results of a Multi-Institutional Study.

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Presentation on theme: "How Surgical Faculty and Residents Assess the First Year of the ACGME Duty-Hour Restrictions Results of a Multi-Institutional Study."— Presentation transcript:

1 How Surgical Faculty and Residents Assess the First Year of the ACGME Duty-Hour Restrictions Results of a Multi-Institutional Study

2 James Coverdill, William Finlay –University of Georgia, Athens, GA John D. Mellinger, Gina L. Adrales –Medical College of Georgia, Augusta, GA Kimberly D. Anderson –University of Texas, Houston, TX Bruce W. Bonnell –Michigan State University, Grand Rapids, MI Joseph B. Cofer –University of Tennessee, Chattanooga, TN Douglas Dorner –Iowa Health, Des Moines, IA Carl Haisch –East Carolina University, Greenville, NC Kristi L. Harold –Mayo Clinic, Scottsdale, AZ Paula Termuhlen –Wright State University, Dayton, OH Alexandra L. B. Webb, –Emory University, Atlanta, GA Acknowledgements: Mary Anne Park, Medical College of Georgia; Jim Bason, University of Georgia, Daniel Hall, University of Georgia

3 1984 Libby Zion wrongful death suit filed doctors found negligent in Libby Zion case 1987 NY ad hoc Advisory committee established to evaluate GME 1989 NY “405” regulations 2003 ACGME “80-hour/week” restriction Baldwin et al survey: average surgical intern hours 102/wk 1999 NIM report 44-98K deaths/yr due to medical error

4 The Doctor Is Out Some fourteen years after the Libby Zion case changed the way hospitals are run—and medicine is taught—it’s clear that residents are getting more sleep. But many doctors say that patients—and even the residents—are being shortchanged. New York metro.com November 3, 2003

5 Objective Examine the views of residents and faculty regarding the duty-hour restrictions (DHR) within a multi-institutional study Determine whether faculty and resident assessments diverge Explore factors that influence the differences in views among faculty and residents

6 Methods 9 general surgery residencies in 8 states 5 traditional academic programs 4 non-academic programs –2 community programs –2 “hybrid” programs Surgical residents, PGY-2 or greater Faculty beyond their first year of practice IRB approval at the coordinating centers (UGA, MCG) and the local boards

7 Methods Questionnaire surveys were distributed in June-August 2004 –Items critiqued by director of Survey Research Center, University of Georgia –4-point likert responses (1=strongly agree, 4=strongly disagree) –37-item resident survey –39-item faculty survey 21 items common to both surveys were analyzed for comparison Mean differences were examined with two-tailed t-tests (p<.05)

8 Results Response rates –63% for faculty (N=146) –58% for residents (N=113) Respondents predominantly male –85.6% of faculty –70.8% of residents Program type –Academic 49% residents, 47% faculty respondents –Non-academic 51% residents, 53% faculty

9 Residency Program and Training *Mean responses significantly different, p<.05 * * * * * *

10 Patient Care *Mean responses significantly different, p<.05 * * * * * *

11 Quality of Life/Overall Assessment *Mean responses significantly different, p<.05 * ***

12 Results Few differences were found among faculty responder groups –AGE Deviations from resident responses were significantly different on only 3 of 21 items. Older faculty were more aligned with residents than younger faculty –CLINICAL DUTIES No consistent differences between clinical faculty and research faculty views –CLINICAL DUTIES 4 of 21 items significantly different. No consistent differences between clinical faculty and research faculty views –GENDER No significant difference among 21 items No differences based on program type There were significant differences based on resident gender. Mean responses on 11 of 21 items were significantly different.

13 Gender Differences Resident Program and Training *Mean responses between male and female residents significantly different, p<.05 * * **

14 Gender Differences Patient Care *Mean responses between male and female residents significantly different, p<.05 * * * * *

15 Gender Differences Overall Assessment of DHR *Mean responses between male and female residents significantly different, p<.05 * *

16 Conclusions Apparent tension between support of DHR and concern about their consequences Majority of residents and faculty believe that lack of familiarity, not fatigue, are the major cause of medical error Significant divergence between residents and faculty regarding DHR effects on training and patient care; Residents view DHR more favorably

17 Faculty age, faculty gender, program type did not systematically factor into the differences between faculty and resident views Resident gender was a strong and consistent factor in the faculty-resident gap This may lead to discord in residency programs and create tension between female residents and faculty Conclusions

18 Limitations –Relies on subjective assessments –Subgroup sizes fairly small (Faculty gender, program type) –Could not evaluate reliably differences due to level of resident training Gender issues in regard to DHR should be an area of more intensive investigation Conclusions


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