Background: The literature on graduate medical education contains
anecdotal reports of some effects of the new eighty-hour workweek on the
attitudes and performance of residents. However, there are relatively few
studies detailing the attitudes of large numbers of residents in a particular
surgical specialty toward the new requirements.
Methods: Between July and November 2004, a survey created by the
Academic Advocacy Committee of the American Academy of Orthopaedic Surgeons
was distributed by mail, fax, and e-mail to a total of 4207 orthopaedic
residents at the postgraduate year-1 through year-6 levels of training. The
survey responses were tabulated electronically, and the results were
Results: The survey response rate was 13.2% (554 residents).
Sixty-eight percent (337) of the 495 respondents whose postgraduate-year level
was known were at the postgraduate year-4 level or higher. Attitudes
concerning the duty rules were mixed. Twenty-three percent of the 554
respondents thought that eighty hours constituted an appropriate number of
duty hours per week; 41% believed that eighty hours were too many, and 34%
thought that eighty hours were not sufficient. Thirty-three percent of the
respondents had worked greater than eighty hours during at least a single
one-week period since the new rules were implemented; this occurred more
commonly among the postgraduate year-3 and more junior residents. Orthopaedic
trauma residents had the most difficulty adhering to the new duty-hour
restrictions. Eighty-two percent of the respondents indicated that their
residency programs have been forced to make changes to their call schedules or
to hire ancillary staff to address the rules. The use of physician assistants,
night-float systems, and so-called home-call assignments were the most common
strategies used to achieve compliance.
Conclusion: Resident attitudes toward the work rules are mixed. The
rules have forced residency programs to restructure. Junior residents have
more favorable attitudes toward the new standards than do senior residents.
Self-reporting of duty hours is the most common method of monitoring in
orthopaedic training programs. Such systems allow ample opportunity for
inaccuracies in the measurement of hours worked. Although residents report an
improved quality of life as a result of these new rules, the attitude that the
quality of training is diminished persists.