Search

Objective: Since 2003, compliance with Accreditation Council on Graduate Medical Education (ACGME) work hours regulations has been required for United States residency training programs. Further work hours restrictions have been proposed by the Institute of Medicine (IOM). This study examines General Surgery residents' views of current work hours restrictions and proposed changes by the IOM., Design: An anonymous multiple-choice survey regarding work hours regulations was distributed to all US General Surgery residency program directors in 2009. Responses were compiled via an on-line survey program. Statistical analysis was performed in aggregate and by junior and senior resident responses., Results: Nine hundred sixty-five (13.1%) general surgery residents responded. Responses demonstrated that 25% of surgery residents underreported work hours, with statistically significant differences between junior (22%) and senior residents (27%), p = 0.03. Sixteen percent of residents indicated they were instructed to report their work hours inaccurately, while 8% of residents advised junior or coresidents to report their work hours inaccurately. Sixty-five percent felt that other residents underreport their work hours. Junior residents (34%) were more in favor of increased work hours regulations than senior residents (17%; p < 0.001). The majority (52%) have underreported work hours to take care of a sick patient or perform surgery. Seventy-six percent are aware of the recent IOM recommendations for further work hours restrictions, of whom the majority felt that the IOM recommendations would make surgical training worse., Conclusions: General surgery resident physicians in the US do not always record their work hours accurately and many have concerns about further work hour restrictions. The majority admitted underreporting work hours to care for a sick patient. Most US surgical residents feel further work hour restrictions would be detrimental to their training. Current work hours restrictions force surgery residents to underreport their work hours to perform the activities that they feel are necessary for their surgical training., (Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The Accreditation Council for Graduate Medical Education (ACGME) uses the resident/fellow survey to assess residency programs compliance with ACGME work hours regulations. Survey results can have significant consequences for residency programs including ACGME letters of warning, shortened program accreditation cycle, immediate full program and institutional site visits, or administrative withdrawal of a program's accreditation. Survey validity was assessed by direct query of general surgery residents who answer the survey each year. A multiple-choice survey was created to assess all US general surgery residents' interpretation and understanding of the ACGME survey. The survey was distributed to all surgery residency program directors in the US in 2009. Responses were compiled via an online survey program. Statistical analysis was performed in aggregate and between junior and senior residents. Nine hundred sixty-five (13.2%) general surgical residents responded with 961 (99.6%) completing all questions. All responding residents had taken the ACGME survey at least once with 634 (66%) having taken it more than once. Nineteen percent of residents had difficulty understanding the questions with senior residents (23%) reporting difficulty more than junior residents (14%), p < 0.001. Thirty-five percent of residents had discussed the survey with their faculty or program director prior to taking it, while 17% were instructed on how to answer the survey. One hundred thirty-three residents (14%) admitted to not answering the questions truthfully while 352 (37%) of residents felt that the survey did not provide an accurate evaluation of their work hours in residency training. An evaluation tool in which 1 in 7 residents admit to answering the questions falsely and 1 in 5 residents had difficulty interpreting the questions may not be a valid method to evaluate compliance with work hours regulations. Evaluation of work hours regulations compliance should be based on actual work hours data rather than an anonymous survey., (Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)