Demographic information about programs and responding faculty and residents is shown in . shows participants’ perspectives on the current ACGME limits and the IOM committee recommendations. Fifty-two percent of faculty perceived that the ACGME duty hour limits currently in effect have resulted in a decline in the quality of residency training, 31.9% reported no change, and 15.9% perceived improved training quality. Perceptions differed by program size: larger programs were more polarized (either positive or negative about the work regulations) than smaller programs (χ2
.009). Respondents’ own training influenced their assessment, with faculty who trained prior to duty hour limits more negative in their perceptions than those educated under an 80-hour limit (χ2
< .001). The greatest improvements perceived were a reduction of resident fatigue (60.4%) and increased resident satisfaction with training (36.0%). Positive effects did not differ across program size. However, faculty who trained under the 80-hour regulations were significantly more likely to cite positive effects.
Characteristics of Respondents
Perceptions of Current Work Hours Regulations
A decrease in residents’ ownership of their patients (83.8%) was the most widespread reported negative effect of the limits. Other negative perceptions included the belief that additional free time was not used for education or research (70.8%), increased patient errors related to handoffs (51.5%), and perceived decline in patient satisfaction (50.0%).
Respondents anticipated significant effects from an implementation of the proposed reductions in maximum shift length (87.8%), night call frequency (85.9%), time off per month (85.1%) and, to a lesser degree, minimum rest time between shifts (65.2%), as shown in . Three-fourths (77.1%) of faculty respondents anticipated an increase in the number of residents who comply with the proposed changes, and the majority (93.0%) expect that hospitalists and nurse practitioners will pick up the additional clinical workload. Three-fourths (77.0%) expect that the proposed changes may require a lengthened residency to provide adequate patient exposure, and 68.3% reported fear that this increase would result in fewer students choosing internal medicine. Additional comments were volunteered by 47 faculty respondents, who voiced further concerns about quality of care, preparation for practice, and a negative effect on resident training.
Anticipated Outcomes of Proposed Changes to Residency Hours
Most (70.9%) resident respondents were in their first 2 years of training. Faculty and resident respondents were similar in terms of program size and moonlighting policy (). Less than half (43.9%) of the residents reported they experienced severe fatigue once a month or more that interfered with patient care. Fatigue was most likely among first-year residents. Forty-eight percent of residents reported that they had experienced a severe stress reaction once or more a month, with long work hours (66.4%) and patient load (60.2%) the most frequently mentioned sources of stress. Residents who moonlighted were more likely to report having experienced stress reactions attributed to their patient load and work environment.
Fatigue and Stress amongst Residents Currently Training
A majority (61.8%) of residents regard the current ACGME regulations as providing a balance of service and education (), and residents are split regarding whether further decreases in work hours would result in positive or negative effects for training; senior residents tended to be more negative in their expectations. Residents anticipated that the reductions would result in more time for research (81.6%) and less fatigue (74.8%), but would be accompanied by an increase in patient handoffs (74.0%).
Resident Perspectives on Current and Proposed Regulations