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Symposium Resident Work-Hour GuidelinesA Sentence or An Opportunity for Orthopaedic Education?*
Vincent D. PellegriniJr., MD1; Terrance Peabody, MD2; David F. Dinges, PhD3; Jennifer Moody4; Peter J. Fabri, MD5
1 Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Suite S 11 B, Baltimore, MD 21201. E-mail address: vpellegrini@umoa.umm.edu
2 University of Chicago School of Medicine, 5841 Maryland Avenue, MC 3079, Chicago, IL 60637
3 University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104
4 AmeriMed Consulting, 5001 Statesman Drive, Irving, TX 75063
5 University of South Florida College of Medicine, 12902 Bruce B. Downs Boulevard, Box 41, Tampa, FL 33612
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Presented at the Annual Meeting of the American Orthopaedic Association, Boston, Massachusetts, June 25, 2004.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Nov 01;87(11):2576-2586. doi: 10.2106/JBJS.E.00972
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Not since 1910, when Abraham Flexner established a set of standards and an accreditation process for schools of medicine in the United States1, has the foundation of American medical education been so shaken as it has by the 2001 Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. Predicated on imperatives derived from a public call for regulation and accountability in support of patient safety and an evolving appreciation of the education process and the optimal learning environment, the ACGME instituted standards and limitations for the work hours of residents participating in accredited programs2. Amid protest largely from the sector of surgical specialists during the period of preparation and review, these restrictions were approved in February 2003 and became effective on July 1, 2003.
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    Arif Gul
    Posted on November 02, 2005
    European Working Time Directives - A UK perspective
    Oxford Radcliffe Hospitals, UNITED KINGDOM

    To The Editor:

    I read with great interest the article by Pellegrini, et al, about resident working hours guidelines in the USA. The effect of work hour guidelines was described as negative by about 75%, positive by 17% and neutral by 7% of the programme directors. The residents attitude was positive in 54%, negative in 42% and neutral in 4%.

    The Royal College of Surgeons and British Orthopaedic Trauma Association carried out a similar survey in the UK after the implementation of the European Working Time Directive(1). Eighty two per cent of survey respondents said that their training time in theatre had decreased, and almost three quarters considered that direct contact time with their trainer(s) had decreased. More than half (58%) said that training time in outpatient clinics had also decreased. As far as quality of life is concerned 42% of the trainees said it had worsened, 33% said it had improved and rest were unsure.

    There is a huge discrepancy in the working hour patterns in the two countries. While our counterparts in the USA are still working 80 hours a week; the European Working Time Directive which is followed in the UK limits the working week for junior doctors to a maximum of 58 hours, with a reduction to 56 hours in 2007 and 48 hours in 2009. Surgeons who trained several years ago in the UK would have accumulated approximately 32000 hours of training, but now it has fallen to 6000(1). Training a surgeon takes time and that time must be spent in theatre, out patient clinics, and the wards and if nothing is done about it the safety of tomorrow’s patients may be in jeopardy.


    Arif Gul MS, MRCS

    S. Sambandam MS, MRCS


    1.Mayor S. UK surgeons report that EU directive has cut training time. BMJ Mar 5 2005;330(7490):499.

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