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Published in: Journal of General Internal Medicine 11/2020

01-11-2020 | Original Research

Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements

Authors: Kathleen M. Finn, MD, M.Phil., Andrew J. Halvorsen, MS, Saima Chaudhry, MD, Sanjay Desai, MD, Denise Dupras, MD, PhD, Shalini Reddy, MD, Sandhya Wahi-Gururaj, MD, MPH, Lisa Willett, MD, MACM, Aimee K. Zaas, MD, MHS

Published in: Journal of General Internal Medicine | Issue 11/2020

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Abstract

Background

The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multi-center randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017.

Objective

We sought to determine program directors’ (PDs) support for the work hour changes and programmatic response.

Design

In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions.

Key Results

The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38–58, 13/69 [19%]; 59–100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%).

Conclusions

Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs’ decisions to change trainee schedules.
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Literature
1.
go back to reference Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA 2002;288:1112-4.PubMed Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA 2002;288:1112-4.PubMed
2.
go back to reference Nasca TJ, Day SH, Amis ES, Jr., Force ADHT. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010;363:e3.PubMed Nasca TJ, Day SH, Amis ES, Jr., Force ADHT. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010;363:e3.PubMed
3.
go back to reference Fletcher KE, Underwood W, 3rd, Davis SQ, Mangrulkar RS, McMahon LF, Jr., Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA 2005;294:1088-100.PubMed Fletcher KE, Underwood W, 3rd, Davis SQ, Mangrulkar RS, McMahon LF, Jr., Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA 2005;294:1088-100.PubMed
4.
go back to reference Sehgal NL, Shah HM, Parekh VI, Roy CL, Williams MV. Non-housestaff medicine services in academic centers: models and challenges. J Hosp Med 2008;3:247-55.PubMed Sehgal NL, Shah HM, Parekh VI, Roy CL, Williams MV. Non-housestaff medicine services in academic centers: models and challenges. J Hosp Med 2008;3:247-55.PubMed
5.
go back to reference Blanchard MS, Meltzer D, Polonsky KS. To nap or not to nap? Residents’ work hours revisited. N Engl J Med 2009;360:2242-4.PubMed Blanchard MS, Meltzer D, Polonsky KS. To nap or not to nap? Residents’ work hours revisited. N Engl J Med 2009;360:2242-4.PubMed
6.
go back to reference Barone JE, Ivy ME. Resident work hours: the five stages of grief. Acad Med 2004;79:379-80.PubMed Barone JE, Ivy ME. Resident work hours: the five stages of grief. Acad Med 2004;79:379-80.PubMed
8.
go back to reference Rybock JD. Residents’ duty hours and professionalism. N Engl J Med 2009;361:930-1.PubMed Rybock JD. Residents’ duty hours and professionalism. N Engl J Med 2009;361:930-1.PubMed
9.
go back to reference Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ. Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med 2009;360:2202-15.PubMed Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ. Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med 2009;360:2202-15.PubMed
10.
go back to reference Antiel RM, Thompson SM, Hafferty FW, et al. Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors. Mayo Clin Proc 2011;86:185-91.PubMedPubMedCentral Antiel RM, Thompson SM, Hafferty FW, et al. Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors. Mayo Clin Proc 2011;86:185-91.PubMedPubMedCentral
11.
go back to reference Antiel RM, Thompson SM, Reed DA, et al. ACGME duty-hour recommendations - a national survey of residency program directors. N Engl J Med 2010;363:e12.PubMedPubMedCentral Antiel RM, Thompson SM, Reed DA, et al. ACGME duty-hour recommendations - a national survey of residency program directors. N Engl J Med 2010;363:e12.PubMedPubMedCentral
12.
go back to reference Mir HR, Cannada LK, Murray JN, Black KP, Wolf JM. Orthopaedic resident and program director opinions of resident duty hours: a national survey. J Bone Joint Surg Am 2011;93:e1421-9.PubMed Mir HR, Cannada LK, Murray JN, Black KP, Wolf JM. Orthopaedic resident and program director opinions of resident duty hours: a national survey. J Bone Joint Surg Am 2011;93:e1421-9.PubMed
13.
go back to reference Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, McMahon LF, Jr., Saint S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004;141:851-7.PubMed Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, McMahon LF, Jr., Saint S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004;141:851-7.PubMed
14.
go back to reference Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA 2007;298:975-83.PubMed Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA 2007;298:975-83.PubMed
15.
go back to reference Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med 2013;173:657-62; discussion 63.PubMedPubMedCentral Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med 2013;173:657-62; discussion 63.PubMedPubMedCentral
16.
go back to reference Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med 2013;173:649-55.PubMed Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med 2013;173:649-55.PubMed
17.
go back to reference Bilimoria KY, Chung JW, Hedges LV, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med 2016;374:713-27.PubMed Bilimoria KY, Chung JW, Hedges LV, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med 2016;374:713-27.PubMed
18.
go back to reference Desai SV, Asch DA, Bellini LM, et al. Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine. N Engl J Med 2018;378:1494-508.PubMedPubMedCentral Desai SV, Asch DA, Bellini LM, et al. Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine. N Engl J Med 2018;378:1494-508.PubMedPubMedCentral
19.
go back to reference Silber JH, Bellini LM, Shea JA, et al. Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules. N Engl J Med 2019;380:905-14.PubMedPubMedCentral Silber JH, Bellini LM, Shea JA, et al. Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules. N Engl J Med 2019;380:905-14.PubMedPubMedCentral
20.
go back to reference Burchiel KJ, Zetterman RK, Ludmerer KM, et al. The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment. J Grad Med Educ 2017;9:692-6.PubMedPubMedCentral Burchiel KJ, Zetterman RK, Ludmerer KM, et al. The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment. J Grad Med Educ 2017;9:692-6.PubMedPubMedCentral
21.
go back to reference O’Connor AB, Halvorsen AJ, Cmar JM, et al. Internal Medicine Residency Program Director Burnout and Program Director Turnover: Results of a National Survey Am J Med. 2019;132(2):252–61. O’Connor AB, Halvorsen AJ, Cmar JM, et al. Internal Medicine Residency Program Director Burnout and Program Director Turnover: Results of a National Survey Am J Med. 2019;132(2):252–61.
22.
go back to reference Ayyala MS, Chaudhry S, Windish D, Dupras D, Reddy ST, Wright SM. Awareness of Bullying in Residency: Results of a National Survey of Internal Medicine Program Directors. J Grad Med Educ 2018;10:209–13.PubMedPubMedCentral Ayyala MS, Chaudhry S, Windish D, Dupras D, Reddy ST, Wright SM. Awareness of Bullying in Residency: Results of a National Survey of Internal Medicine Program Directors. J Grad Med Educ 2018;10:209–13.PubMedPubMedCentral
24.
go back to reference Kogan JR, Lapin J, Aagaard E, et al. The effect of resident duty-hours restrictions on internal medicine clerkship experiences: surveys of medical students and clerkship directors. Teach Learn Med 2015;27:37-50.PubMed Kogan JR, Lapin J, Aagaard E, et al. The effect of resident duty-hours restrictions on internal medicine clerkship experiences: surveys of medical students and clerkship directors. Teach Learn Med 2015;27:37-50.PubMed
25.
go back to reference Jamal MH, Rousseau MC, Hanna WC, Doi SA, Meterissian S, Snell L. Effect of the ACGME duty hours restrictions on surgical residents and faculty: a systematic review. Acad Med 2011;86:34-42.PubMed Jamal MH, Rousseau MC, Hanna WC, Doi SA, Meterissian S, Snell L. Effect of the ACGME duty hours restrictions on surgical residents and faculty: a systematic review. Acad Med 2011;86:34-42.PubMed
26.
go back to reference Noronha C, Chaudhry S, Chacko K, et al. X + Y Scheduling Models in Internal Medicine Residency Programs: A National Survey of Program Directors’ Perspectives. Am J Med 2018;131:107-14.PubMed Noronha C, Chaudhry S, Chacko K, et al. X + Y Scheduling Models in Internal Medicine Residency Programs: A National Survey of Program Directors’ Perspectives. Am J Med 2018;131:107-14.PubMed
27.
go back to reference Jagsi R, Weinstein DF, Shapiro J, Kitch BT, Dorer D, Weissman JS. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours and patient safety. A study of resident experiences and perceptions before and after hours reductions. Arch Intern Med 2008;168:493-500.PubMed Jagsi R, Weinstein DF, Shapiro J, Kitch BT, Dorer D, Weissman JS. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours and patient safety. A study of resident experiences and perceptions before and after hours reductions. Arch Intern Med 2008;168:493-500.PubMed
28.
go back to reference Matulewicz RS, Odell DD, Chung JW, Ban KA, Yang AD, Bilimoria KY. Association Between Resident Perceptions of Patient Safety and Duty Hour Violations. J Am Coll Surg 2017;224:113-7 e4.PubMed Matulewicz RS, Odell DD, Chung JW, Ban KA, Yang AD, Bilimoria KY. Association Between Resident Perceptions of Patient Safety and Duty Hour Violations. J Am Coll Surg 2017;224:113-7 e4.PubMed
30.
go back to reference Williams D, Tricomi G, Gupta J, Janise A. Efficacy of burnout interventions in the medical education pipeline. Acad Psychiatry 2015;39:47-54.PubMed Williams D, Tricomi G, Gupta J, Janise A. Efficacy of burnout interventions in the medical education pipeline. Acad Psychiatry 2015;39:47-54.PubMed
Metadata
Title
Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements
Authors
Kathleen M. Finn, MD, M.Phil.
Andrew J. Halvorsen, MS
Saima Chaudhry, MD
Sanjay Desai, MD
Denise Dupras, MD, PhD
Shalini Reddy, MD
Sandhya Wahi-Gururaj, MD, MPH
Lisa Willett, MD, MACM
Aimee K. Zaas, MD, MHS
Publication date
01-11-2020
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine / Issue 11/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-020-06109-1

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