Association Between Resident Duty Hours and Self-study Time Among Postgraduate Medical Residents in Japan

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in. Purpose To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals. Methods We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a “fatigued post-call intern who admitted patient” versus “well-rested covering intern who just picked up patient” for various clinical scenarios. Results Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42–3.85, P = .001). Conclusions Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity.

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The Effect of Resident Duty-Hours Restrictions on Internal Medicine Clerkship Experiences: Surveys of Medical Students and Clerkship Directors

Teaching and Learning in Medicine ◽

10.1080/10401334.2014.979187 ◽

2015 ◽

Vol 27 (1) ◽

pp. 37-50 ◽

Cited By ~ 5

Author(s):

Jennifer R. Kogan ◽

Jennifer Lapin ◽

Eva Aagaard ◽

Christy Boscardin ◽

Meenakshy K. Aiyer ◽

...

Keyword(s):

Internal Medicine ◽

Medical Students ◽

Medicine Clerkship ◽

Duty Hours ◽

Internal Medicine Clerkship ◽

Resident Duty

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Implementation of duty hour standards in otolaryngology-head and neck surgery residency training

Otolaryngology ◽

10.1016/j.otohns.2005.03.004 ◽

2005 ◽

Vol 132 (6) ◽

pp. 819-822 ◽

Cited By ~ 18

Author(s):

Todd A. Kupferman ◽

Tim S. Lian

Keyword(s):

Head And Neck ◽

Residency Training ◽

Training Programs ◽

Neck Surgery ◽

Program Directors ◽

The United States ◽

Head And Neck Surgery ◽

Training Experience ◽

Duty Hours ◽

Resident Duty

OBJECTIVE: To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States. STUDY DESIGN AND SETTING: Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States. RESULTS: Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions. CONCLUSIONS: According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents. SIGNIFICANCE: This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.

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Private Tutoring and Academic Achievement: Self-Study as a Mediator

Social Behavior and Personality An International Journal ◽

10.2224/sbp.6689 ◽

2018 ◽

Vol 46 (5) ◽

pp. 823-830 ◽

Cited By ~ 2

Author(s):

Eun Hee Seo

Keyword(s):

Academic Achievement ◽

Middle School Students ◽

Private Tutoring ◽

Study Time ◽

School Students ◽

Mediating Role ◽

Self Study ◽

The Relationship ◽

Positive Effect

I examined the relationships among private tutoring in mathematics, self-study, and academic achievement, in particular, the potential mediating role of self-study in the relationship between private tutoring and academic achievement. The responses of 3,689 Korean middle school students were analyzed. Results showed that private tutoring time positively predicted self-study time and academic achievement. Number of hours of self-study also predicted academic achievement and mediated the relationship between private tutoring and academic achievement. These findings showed that private tutoring increased the time students spent on self-study rather than replacing it. In addition, the positive effect of private tutoring on academic achievement was mediated by increased self-study time. Practical and theoretical implications are discussed.

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A study of resident duty hours and burnout in a sample of Saudi residents

BMC Medical Education ◽

10.1186/s12909-018-1300-5 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

Tahir Kamal Hameed ◽

Emad Masuadi ◽

Nejoud Ali Al Asmary ◽

Faisal Ghayb Al-Anzi ◽

Mohammed Saleh Al Dubayee

Keyword(s):

Duty Hours ◽

Resident Duty

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Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine

BMJ Open ◽

10.1136/bmjopen-2018-021711 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021711 ◽

Cited By ~ 3

Author(s):

Judy A Shea ◽

Jeffrey H Silber ◽

Sanjay V Desai ◽

David F Dinges ◽

Lisa M Bellini ◽

...

Keyword(s):

Internal Medicine ◽

Patient Safety ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Medicare Beneficiaries ◽

Internal Medicine Training ◽

Duty Hours ◽

Time Motion ◽

Wrist Actigraphy ◽

Resident Duty

IntroductionMedical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness.Methods and analysis63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses.Ethics and disseminationThe University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process.Trial registration numberNCT02274818; Pre-results.

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New standards for resident duty hours and the potential impact on the neonatal nurse practitioner role

Advances in Neonatal Care ◽

10.1016/s1536-0903(03)00144-9 ◽

2003 ◽

Vol 3 (4) ◽

pp. 159-161 ◽

Cited By ~ 14

Author(s):

L Juretschke

Keyword(s):

Nurse Practitioner ◽

Duty Hours ◽

Resident Duty ◽

Potential Impact ◽

Practitioner Role

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Are Resident Work-Hour Limitations Beneficial to the Trauma Profession?

The American Surgeon ◽

10.1177/000313480607200109 ◽

2006 ◽

Vol 72 (1) ◽

pp. 35-41 ◽

Cited By ~ 2

Author(s):

Tara Abraham ◽

Marilee Freitas ◽

Spiros Frangos ◽

Heidi L. Frankel ◽

Reuven Rabinovici

Keyword(s):

General Surgery ◽

National Level ◽

Work Hours ◽

Emergency General Surgery ◽

Duty Hours ◽

Likert Score ◽

Resident Work ◽

Work Hour ◽

Resident Duty ◽

Level I

In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts >30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 ± 0.5 vs Likert score 2.5 ± 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with <1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.

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