Surgical Interns Worried About Limits on Training Hours

Lara C. Pullen, PhD

June 20, 2012

June 20, 2012 — Surgical interns beginning their training are concerned that the program of duty hour restrictions, new as of 2011, will have a negative effect on their training. Interns are also concerned about continuity of care under the new duty hour rules, according to a new survey.

Ryan M. Antiel, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues published the results of the survey in the June issue of the Archives of Surgery. The authors surveyed 215 interns and 134 surgery program directors.

The study provides important insights into the perceptions of new surgical interns who began their training under the new 2011 work hour restrictions. The authors note that resident attitudes may not be stable and that that the survey captured only the view of incoming interns.

The survey was completed by 179 (83.3%) of interns. Although 61.5% of interns felt that the standards would decrease resident fatigue, 85.1% of program directors believed that fatigue would remain unchanged or increase with new standards (P < .001 for the difference between these 2 perspectives).

Most interns believed that the new duty hour regulations will decrease continuity with patients (80.3%), time spent operating (67.4%), and coordination of patient care (57.6%). Many of these concerns are similar to those expressed by surgical societies. Specifically, the American Board of Surgery issued a statement calling the duty hour recommendations "incompatible with the realities of surgical resident training." Surgical interns were significantly less pessimistic than surgery program directors on all aspects of the effect of duty hour rules on surgical training (P < .05).

In an accompanying invited critique, Mark L. Friedell, MD, from the Department of Surgery, University of Missouri in Kansas City, writes: "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 no further resident duty-hour restrictions."

Previous studies have shown that duty hour regulations implemented in 2003 resulted in reduced operative experience.

The authors and commentators have disclosed no relevant financial relationships.

Arch Surg. 2012:147:536-541. Article full text, Critique full text