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Mark J. Niederee, MD; Jason L. Knudtson, MD; Matthew C. Byrnes, MD; Stephen D. Helmer, PhD; R. Stephen Smith, MD

Arch Surg. 2003;138:663-671.

Hypothesis  Surgical faculty and residents have significantly different attitudes regarding work hour restrictions.

Setting  All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME).

Participants  All voluntarily participating surgical faculty and residents.

Main Outcome Measures  Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment.

Methods  A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis.

Results  Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery.

Conclusions  Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.

From the Department of Surgery, University of Kansas School of Medicine, Wichita.

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