Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation

A Survey of Chief Residents

Compliance with work hour limitations imposed on medical residents in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) has been high, but few studies have examined the impact of the regulations on residents' opportunities for clinical experience and formal education. The authors of this study evaluated responses to surveys inquiring into changes in time assigned to ward coverage and hours allotted to formal education which were mailed to chief residents at 324 internal medicine residency programs (62% response rate). They were not surprised to find that inpatient care experience, as represented by the number of patients admitted, was generally redistributed rather than substantively decreased after work hour regulation. A substantial minority of residency programs reduced elective opportunities for third-year residents and increased their ward and float time, raising concern that the breadth of clinical experience may have changed.

The authors found no significant change in hours allotted to formal educational activities after work hour regulations were instituted, but over half the respondents reported a decrease in intern attendance at educational activities, and a quarter reported a decrease equivalent to two hours a week or more. They caution, nonetheless, that decreased attendance at educational activities does not necessarily translate to decreased knowledge. The open-ended comments received suggest several areas for further research, including possible adverse effects on clinical and educational performance created by decreased continuity of care.