Duty Hour Restrictions Limit Practice Time for Surgery Interns, Study Says
First-year surgical interns are getting less experience performing or assisting with surgeries as a result of the 16-hour workday cap enacted in July 2011 by the Accreditation Council for Graduate Medical Education, according to a study in JAMA Surgery.
In a review of 10 West Coast general surgery residency programs, researchers found 2011-2012 interns recorded a 25.8 percent decrease in total operative cases as compared with the preceding four years before the cap was enacted. There was also a 31.8 percent decrease in cases performed primary by the interns, under faculty supervision, and a 46.3 percent decrease in cases in which the interns assisted a faculty member.
“The decline in operative case volume in our present study is in some respects surprising given that the new duty-hour changes did not mandate a reduction in an overall 80-hour work week for interns,” the researchers write. “Thus, interns were presumably working the same number of total hours.” The program directors surveyed in the study reported that their predominant solution to the 16-hour rule was to expand the “night-float” system, meaning interns are increasingly working overnight when there are fewer intern-level, elective surgeries taking place.
There are several implications of the reduced operative experience, the authors caution. “Although it is convenient to believe that the decrease in operative volume is unlikely to be catastrophic in terms of overall surgery resident training, it will clearly create a new pool of less-experienced residents at the second-year level,” they write, which could have a “domino effect on subsequent competence.”
The authors of the study are: Samuel I. Schwartz, MD; Joseph Galante, MD; Amy Kaji, MD, PhD; Matthew Dolich, MD; David Easter, MD; Marc L. Melcher, MD, PhD; Kevin Patel, MD; Mark E. Reeves, MD, PhD; Ali Salim, MD; Anthony J. Senagore, MD; Danny M. Takanishi, Jr, MD; and Christian de Virgilio, MD.