Survey of internal medicine physicians trained in three different eras: reflections on duty-hour reform.

In 2003 the Accreditation Council for Graduate Medical Education (ACGME) placed restrictions on the number of hours worked by resident physicians, limiting the work week to 80 hours averaged across 4 weeks.1 These restrictions resulted in a structural change to many residency programs in which residents had previously routinely exceeded the 80-hour work week. It also initiated a debate about the ability to care for patients and to educate future physicians under the new guidelines. After the institution of duty-hour restrictions in 2003, internal medicine (IM) residents reported spending less time teaching.2 Satisfaction among residents within the clinical environment improved,3 and small improvements in residents’ quality of life were reported.4 Residents did not develop a shift work mentality and were found to place the highest value on delivering high-quality patient care.5 In July 2011, further duty-hour restrictions went into effect, which had the largest impact on interns (postgraduate year 1), limiting their continuous duty hours to 16, and continuing to restrict the work week to 80 hours averaged across 4 weeks. Senior residents (postgraduate year 2 and up) are allowed to work 24 hours of continuous duty plus an additional 4 hours to complete work from a previous shift. As a result of these changes, the medical community is assessing the impact on resident education and the quality of patient care and safety. Residents and residency program directors held mixed opinions of the proposed duty-hour restrictions before 2011. The majority of IM residents surveyed anticipated further duty-hour restrictions would “occasionally,” “usually,” or “always” improve patient care,6 with 66.99% indicating that resident fatigue (66.9%) “occasionally” could cause medical errors.6 Fifty-five percent of IM program directors anticipated that further duty-hour restrictions would result in either an increase or no change in patient safety, whereas 45% anticipated that patient safety would decrease.7 Although 82.2% of program directors believed the proposed duty-hour restrictions would have an adverse effect on the clinical experience during their intern year, the majority anticipated no change in the quality of fellowship applicants from residency programs.7 Studies piloting schedules in compliance with the 2011 ACGME duty-hour restrictions were completed before July 2011 and indicated that results were mixed regarding resident education, with one study finding resident education was not impaired based on resident performance on a postrotation examination.8 Another study found that residents were less likely to attend educational conferences under the pilot schedule.9 Neither study found a significant difference in patient care quality metrics, including mortality or length of stay.8,9 The purpose of this study was to survey IM physicians and residents who will have completed their residency in three different eras of medical training and compare responses among groups with respect to experiences during their intern year and perceptions of duty-hour reform. Physicians’ experience during their intern year and current career stage will affect their perceptions; therefore, understanding one another’s perceptions of duty-hour reform will help the medical community work together to adapt to the challenges presented by duty-hour reform.