Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study
IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour res...
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| Veröffentlicht in: | JAMA surgery 2013-09, Vol.148 (9), p.829-833 |
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| creator | Schwartz, Samuel I Galante, Joseph Kaji, Amy Dolich, Matthew Easter, David Melcher, Marc L Patel, Kevin Reeves, Mark E Salim, Ali Senagore, Anthony J Takanishi, Danny M de Virgilio, Christian |
| description | IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P |
| doi_str_mv | 10.1001/jamasurg.2013.2677 |
| format | Article |
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Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.</description><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/jamasurg.2013.2677</identifier><identifier>PMID: 23843028</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Education, Medical, Graduate ; General Surgery - education ; Humans ; Internship and Residency ; Retrospective Studies ; United States ; Work Schedule Tolerance ; Workload - standards</subject><ispartof>JAMA surgery, 2013-09, Vol.148 (9), p.829-833</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/jamasurg.2013.2677$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2013.2677$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23843028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwartz, Samuel I</creatorcontrib><creatorcontrib>Galante, Joseph</creatorcontrib><creatorcontrib>Kaji, Amy</creatorcontrib><creatorcontrib>Dolich, Matthew</creatorcontrib><creatorcontrib>Easter, David</creatorcontrib><creatorcontrib>Melcher, Marc L</creatorcontrib><creatorcontrib>Patel, Kevin</creatorcontrib><creatorcontrib>Reeves, Mark E</creatorcontrib><creatorcontrib>Salim, Ali</creatorcontrib><creatorcontrib>Senagore, Anthony J</creatorcontrib><creatorcontrib>Takanishi, Danny M</creatorcontrib><creatorcontrib>de Virgilio, Christian</creatorcontrib><title>Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study</title><title>JAMA surgery</title><addtitle>JAMA Surg</addtitle><description>IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.</description><subject>Education, Medical, Graduate</subject><subject>General Surgery - education</subject><subject>Humans</subject><subject>Internship and Residency</subject><subject>Retrospective Studies</subject><subject>United States</subject><subject>Work Schedule Tolerance</subject><subject>Workload - standards</subject><issn>2168-6254</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMlOwzAURS0Eggr4ARbISzYpnmIn7KqqUKSiLpiWkZO8gCFD8YDUv8dRoXjzLPvc-6SD0AUlU0oIvf7QnXbBvk0ZoXzKpFIHaMKozBLJJDvc31Nxgs6d-yDxZIQInh-jE8YzwQnLJqhbNA1UHg8N9u-AqUyWQ7D4dbCfeGU6E396fAc9WN3ix7gP7Bbf9x5sj9eb-OrNN-C5doBfhjZ0cINn-CG03iSmd9744M3Qj1kf6u0ZOmp06-D8d56i59vF03yZrNZ39_PZKtFMcZ9IqVOaAmiZ17xM8xJow-sSmpJpoWqZ8arOqyrjstFpLRlXVHClVV0RELzS_BRd7Xo3dvgK4HzRGVdB2-oehuCKiAslhEx5RNkOrezgnIWm2FjTabstKClG08Wf6WI0XYymY-jytz-UHdT7yJ_XCFzsgJj9L1SUpJTzHypZhG0</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Schwartz, Samuel I</creator><creator>Galante, Joseph</creator><creator>Kaji, Amy</creator><creator>Dolich, Matthew</creator><creator>Easter, David</creator><creator>Melcher, Marc L</creator><creator>Patel, Kevin</creator><creator>Reeves, Mark E</creator><creator>Salim, Ali</creator><creator>Senagore, Anthony J</creator><creator>Takanishi, Danny M</creator><creator>de Virgilio, Christian</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130901</creationdate><title>Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study</title><author>Schwartz, Samuel I ; Galante, Joseph ; Kaji, Amy ; Dolich, Matthew ; Easter, David ; Melcher, Marc L ; Patel, Kevin ; Reeves, Mark E ; Salim, Ali ; Senagore, Anthony J ; Takanishi, Danny M ; de Virgilio, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a273t-66a515eea69d3b59be1f3dbefb2a47d683cd9cc836fa5d62371437a7dc0e43ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Education, Medical, Graduate</topic><topic>General Surgery - education</topic><topic>Humans</topic><topic>Internship and Residency</topic><topic>Retrospective Studies</topic><topic>United States</topic><topic>Work Schedule Tolerance</topic><topic>Workload - standards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schwartz, Samuel I</creatorcontrib><creatorcontrib>Galante, Joseph</creatorcontrib><creatorcontrib>Kaji, Amy</creatorcontrib><creatorcontrib>Dolich, Matthew</creatorcontrib><creatorcontrib>Easter, David</creatorcontrib><creatorcontrib>Melcher, Marc L</creatorcontrib><creatorcontrib>Patel, Kevin</creatorcontrib><creatorcontrib>Reeves, Mark E</creatorcontrib><creatorcontrib>Salim, Ali</creatorcontrib><creatorcontrib>Senagore, Anthony J</creatorcontrib><creatorcontrib>Takanishi, Danny M</creatorcontrib><creatorcontrib>de Virgilio, Christian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwartz, Samuel I</au><au>Galante, Joseph</au><au>Kaji, Amy</au><au>Dolich, Matthew</au><au>Easter, David</au><au>Melcher, Marc L</au><au>Patel, Kevin</au><au>Reeves, Mark E</au><au>Salim, Ali</au><au>Senagore, Anthony J</au><au>Takanishi, Danny M</au><au>de Virgilio, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study</atitle><jtitle>JAMA surgery</jtitle><addtitle>JAMA Surg</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>148</volume><issue>9</issue><spage>829</spage><epage>833</epage><pages>829-833</pages><issn>2168-6254</issn><eissn>2168-6262</eissn><abstract>IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>23843028</pmid><doi>10.1001/jamasurg.2013.2677</doi><tpages>5</tpages></addata></record> |
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| subjects | Education, Medical, Graduate General Surgery - education Humans Internship and Residency Retrospective Studies United States Work Schedule Tolerance Workload - standards |
| title | Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study |
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