I’ve previously mentioned the controversy surrounding the rules governing resident work hours. But the criticisms and critiques in the past of the work hour rules have come from bodies like the Accreditation Council for Graduate Medical Education (ACGME) and from practicing physicians.
But a new study published in JAMA Surgery actually surveyed the people most affected by the work hour rules – the residents themselves. In a study of over 1000 surgical residents in training, 2/3 of them disapproved of the restrictions on the shifts of the most junior trainee surgeons, first-year surgical interns, to 16 hours and caps on the shifts of the remaining residents at 28 hours. The rules were put into place in order to improve patient care as well as the residents’ education and quality of life. The results of the survey may say otherwise.
40% of respondents claimed that patient care got worse (only 10% reported improvements in patient care), 55% said that their own education had suffered, and nearly 70% reported their was less focus on preparing them to take on a more senior roles. About half of the residents said their work schedules were worse after the change, and about 22% said they were getting less rest despite the limits on work hours. Most striking, nearly 70% of respondents said they were not following the new requirements in on way or another, either by falsifying hours or under reporting.
For the most part, doctors are a dedicated group of professionals. I know I’m biased here, but I would argue that those who choose to undergo 5 years of surgical training are by definition a dedicated group, who enjoy learning and don’t like to abandon their patients. The findings of this study, if anything, prove that residents have a lot of work to do and don’t like missing out on learning opportunities. If the very people who are subjected to the rules are telling us that the rules are making things worse and not better… what exactly are we doing here?