Education ResearchBetter Rested, but More Stressed? Evidence of the Effects of Resident Work Hour Restrictions
Section snippets
Setting
Cincinnati Children's Hospital Medical Center (CCHMC) is a large, free-standing pediatric teaching hospital with 4 general inpatient pediatric teams that do not cover subspecialty patients. General pediatric teams typically consist of 2 interns, 1 senior resident, and 1 hospitalist attending; teams practice family-centered bedside rounds on all patients.20, 21 The intervention occurred during March, which is a month with a consistently high general pediatric census. This study was approved by
Work and Sleep Hours
A total of 1377 intervention and 1486 control group work hours were analyzed representing data gathered from 11 interns (data reported for 92% of 311 intern eligible days). Interns on the intervention team worked fewer hours per week than interns on the control team (66.6 vs 75.9). Intervention interns did not violate any of the 2011 ACGME rules. By comparison, 22% of the 87 shifts worked by the control interns violated the existing 2003 work hour rules.
There was no significant difference in
Discussion
We found that interns working on a schedule that was compliant with the ACGME 2011 work hour limits were better rested at work; however, concerns with overall well-being, education, and professionalism arose during the intervention. Increased work compression seemed to be a significant contributor to the decrease in well-being.
Conclusion
Implementation of 2011 ACGME work hour restrictions should lead to interns who are more rested while at work, which has important patient safety implications. However, without an educational restructuring, these changes may adversely affect both resident and attending perceptions of educational quality. A decline in perceived resident professionalism would not be unexpected. To avoid inadvertently increasing work compression and disrupting educational experience, an up-front investment in
Acknowledgments
Research Support: There were no sources of financial or material support in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript.
Disclosures: Drs Auger and Sieplinga were pediatric chief residents at Cincinnati Children's Hospital Medical Center during the intervention period. Dr Auger's current salary is supported by the Robert Wood Johnson Foundation Clinical Scholars program. Dr Landrigan has served as a
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Drs Auger and Sieplinga were with Cincinnati Children's Hospital Medical Center when the data for this study were collected.
The authors have no conflicts of interest to disclose.