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. “80-hour/week” restriction
1987
NY ad hoc Advisory committee established to evaluate GME
1984
Libby Zion wrongful death suit filed
Baldwin et al survey: average surgical intern hours 102/wk
2003
ACGME
“80-hour/week” restriction
1995
3 doctors found negligent in Libby Zion case
1989
NY “405” regulations
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
Hybrid programs-non-university programs with strong research emphasis and dedicated full-time faculty

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 Respondents predominantly male Program type
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*
Table 2- significant differences between residents and faculty, 16/21 items showed large and significant differences between resident and faculty responses
*Mean responses significantly different, p<.05

10. Patient Care * *Mean responses significantly different, p<.05
Table 2- significant differences between residents and faculty
*Mean responses significantly different, p<.05

11. Quality of Life/Overall Assessment*
Table 2- significant differences between residents and faculty
*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 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.
Tables 3,4-Deviations from resident responses were statistically different between younger and older faculty on only three items
Decrease in faculty standards, increased number of errors, and adherence to DHR is good for patient care

13. Gender Differences Resident Program and Training*
Table 5
*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. Conclusions
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

18. Conclusions 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