Wednesday, July 1, 2015

Effect of the ACGME work-hour restrictions on surgical residents, faculty and patients: a systematic review

Mohammed Jamal, MD, MEd
McGill University

Background: In July 2003, the Accreditation Council of Graduate Medical Education (ACGME) developed guidelines for residents’ work hours for all training programs, and this has resulted in significant restrictions in work hours in residency training programs. Educators in surgical training programs are concerned that this reduction in work hours will adversely affect surgical residents’ education, especially their operative experience.

Purpose: To evaluate the impact of the ACGME reduction in work-hours on the education and training of surgical residents.

Data sources: We searched the English and French literature for articles studying the impact of work hours restrictions on surgical residents’ well-being, education, and patient care and on faculty educators. We used the following databases from 2000-2008: Medline, Embase, Cochrane Central Register of Controlled Trials and ERIC.

Study selection: We retrieved 1048 articles, and included every paper which examined the effects of work-hour limits on surgical training. We excluded opinion papers and editorials. Surgical specialties were defined as any specialty with operative experience, e.g. general surgery, cardiothoracic surgery, neurosurgery, otorhinolaryngology, orthopedics, ophthalmology, and obstetrics and gynecology.

Data extraction: All papers underwent data extraction and assessment of quality by 2 independent reviewers. Disagreements were resolved by consensus.

Data synthesis: Fifty-nine studies were included. Positive and negative outcomes on 1) residents’ education, 2) resident lifestyle, 3) patient care, and 4) surgical faculty were compiled. Overall the effects were positive in the first three categories, but negative on surgical faculty. The papers with the highest quality scores had 39 positive themes and 13 negative themes. Resident education in particular was not negatively affected by the work hour limitations, particularly the operating exposure: 13 papers reported positive or neutral effect on number of operating room cases, and only two papers reporting a negative effect.

Conclusions: This is the largest and most current review of the literature addressing the effect of the ACGME work hour limitations on surgical training. These limitations had a positive effect on residents and patients, but a negative effect on faculty. Most importantly, surgical residents’ operating room experience was not adversely affected.