Preserving operative volume in the setting of the 2011 ACGME duty hour regulations

Christopher P. Scally, Bradley N Reames, Nicholas R. Teman, Danielle M. Fritze, Rebecca M. Minter, Paul G. Gauger

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives The reported influence of Accreditation Council for Graduate Medical Education resident duty hour limitations on operative case volume has been mixed. Additional restrictions instituted in July 2011 further limited the work hours of postgraduate year 1 (PGY-1) residents, threatening to reduce availability for educational and operative activities. In this study, we evaluate our novel intern call schedule, which we hypothesized would preserve operative experience despite these increased restrictions. Design A retrospective analysis of PGY-1 operative reports was conducted. Operations outside of major case categories were excluded. Operative case volumes in the Section of General Surgery for the same period were analyzed, as were average duty hours for each resident. Comparative statistics were generated using Wilcoxon rank sum tests. Setting Single-institution study conducted at the University of Michigan, a tertiary-care academic hospital. Participants Overall, 50 categorical general surgery residents from 2005 to present were included. Three residents were subsequently excluded as they were preliminary interns rather than categorical; 2 residents were excluded having completed their intern years at other institutions. Results The median number of major cases done during the PGY-1 for all evaluated residents was 89 (interquartile range [IQR]: 72-101). For interns between the years 2005 and 2011, the median number of major cases was 87 (IQR: 73-101), whereas interns in the 2011 to 2013 academic years performed 91.5 (IQR: 69.5-101.5, p = 0.91). Although case volume varied between intern classes, no significant differences were observed between any 2 individual classes in the study. Analysis of annual case volumes among each PGY revealed a relative increase of 29% (p < 0.001) among PGY-2 residents, and 20% (p = 0.02) by PGY-3 residents. Relative increases among senior residents (8% for both PGY-4 and PGY-5) did not reach statistical significance. Conclusions Our novel call schedule attempts to minimize prolonged night-float coverage responsibilities for interns in hopes of preserving their operative experience. In spite of increased duty hour restrictions, PGY-1 operative volume has not decreased significantly at our institution. However, in the same time period, PGY-2 and PGY-3 case volume has increased. Our findings highlight the challenges faced by surgical residencies in light of these new restrictions, particularly the 16-hour limit. Additional rigorously designed prospective studies should be conducted to better understand the influence of the most recent Accreditation Council for Graduate Medical Education work hour limitations on the subjective and objective experiences of surgical residents.

Original languageEnglish (US)
Pages (from-to)580-586
Number of pages7
JournalJournal of Surgical Education
Volume71
Issue number4
DOIs
StatePublished - Jan 1 2014

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Graduate Medical Education
Accreditation
Nonparametric Statistics
Appointments and Schedules
resident
regulation
Tertiary Healthcare
Internship and Residency
Prospective Studies
Education
accreditation
surgery
graduate
experience
statistical significance
education
coverage
statistics

Keywords

  • accreditation
  • education
  • general surgery/education
  • graduate workload
  • internship and residency
  • medical

ASJC Scopus subject areas

  • Surgery
  • Education

Cite this

Preserving operative volume in the setting of the 2011 ACGME duty hour regulations. / Scally, Christopher P.; Reames, Bradley N; Teman, Nicholas R.; Fritze, Danielle M.; Minter, Rebecca M.; Gauger, Paul G.

In: Journal of Surgical Education, Vol. 71, No. 4, 01.01.2014, p. 580-586.

Research output: Contribution to journalArticle

Scally, Christopher P. ; Reames, Bradley N ; Teman, Nicholas R. ; Fritze, Danielle M. ; Minter, Rebecca M. ; Gauger, Paul G. / Preserving operative volume in the setting of the 2011 ACGME duty hour regulations. In: Journal of Surgical Education. 2014 ; Vol. 71, No. 4. pp. 580-586.
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abstract = "Objectives The reported influence of Accreditation Council for Graduate Medical Education resident duty hour limitations on operative case volume has been mixed. Additional restrictions instituted in July 2011 further limited the work hours of postgraduate year 1 (PGY-1) residents, threatening to reduce availability for educational and operative activities. In this study, we evaluate our novel intern call schedule, which we hypothesized would preserve operative experience despite these increased restrictions. Design A retrospective analysis of PGY-1 operative reports was conducted. Operations outside of major case categories were excluded. Operative case volumes in the Section of General Surgery for the same period were analyzed, as were average duty hours for each resident. Comparative statistics were generated using Wilcoxon rank sum tests. Setting Single-institution study conducted at the University of Michigan, a tertiary-care academic hospital. Participants Overall, 50 categorical general surgery residents from 2005 to present were included. Three residents were subsequently excluded as they were preliminary interns rather than categorical; 2 residents were excluded having completed their intern years at other institutions. Results The median number of major cases done during the PGY-1 for all evaluated residents was 89 (interquartile range [IQR]: 72-101). For interns between the years 2005 and 2011, the median number of major cases was 87 (IQR: 73-101), whereas interns in the 2011 to 2013 academic years performed 91.5 (IQR: 69.5-101.5, p = 0.91). Although case volume varied between intern classes, no significant differences were observed between any 2 individual classes in the study. Analysis of annual case volumes among each PGY revealed a relative increase of 29{\%} (p < 0.001) among PGY-2 residents, and 20{\%} (p = 0.02) by PGY-3 residents. Relative increases among senior residents (8{\%} for both PGY-4 and PGY-5) did not reach statistical significance. Conclusions Our novel call schedule attempts to minimize prolonged night-float coverage responsibilities for interns in hopes of preserving their operative experience. In spite of increased duty hour restrictions, PGY-1 operative volume has not decreased significantly at our institution. However, in the same time period, PGY-2 and PGY-3 case volume has increased. Our findings highlight the challenges faced by surgical residencies in light of these new restrictions, particularly the 16-hour limit. Additional rigorously designed prospective studies should be conducted to better understand the influence of the most recent Accreditation Council for Graduate Medical Education work hour limitations on the subjective and objective experiences of surgical residents.",
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