Work Hour Regulation for Physician Trainees: Educational and Clinical Outcomes

Summary

Principal Investigator: Kevin Volpp
Affiliation: University of Pennsylvania
Country: USA
Abstract: Regulation of work hours for physicians in training was put in place by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, long after similar regulations were implemented in trucking, aviation, and in other occupations where acute and chronic sleep deprivation raise significant concerns about safety. The impact of duty hour regulation has been controversial. While there is some evidence that this improved mortality outcomes in the short-term, little is known about the impact on educational outcomes, longer-term clinical outcomes, or the mechanisms creating inter-hospital differences in the effectiveness of duty hour reform in improving either clinical or educational outcomes. With assistance from the American Board of Surgery, the American Board of Internal Medicine, the National Board of Medical Examiners, the Association of Program Directors in Internal Medicine and Surgery, and the American College of Physicians, we propose to complete the following specific aims: 1. To describe the variety and frequency of program-level behavioral responses to duty hour reform and resident work conditions by conducting national surveys of program directors and residents in Internal Medicine (IM) and General Surgery (GS) informed by qualitative field work at a sample of IM and GS residency programs. 2. To assess how educational outcomes (board scores) have changed over time in conjunction with duty hour reform for residents in different specialties. 3. To examine how clinical outcomes (mortality, failure-to-rescue, probability of a prolonged length of stay, patient safety indicators) have changed over time beyond the first two years post-duty hour reform. 4. To examine the relationship between changes in educational and clinical outcomes and hospital financial performance, physician extender and nurse staffing levels, and program responses identified in the national survey of program directors. The proposed analysis will be the first to pull together national data on educational and clinical outcomes and will help us understand why duty hour regulation reform for physicians in training worked - or did not work - in terms of improving educational and clinical outcomes. This is an important policy question given that the physicians who are the subject of these reforms provide care to tens of millions of Americans each year. PUBLIC HEALTH RELEVANCE Regulation of duty hours for physicians in training in 2003 represented one of the most significant efforts ever undertaken to improve patient safety in American hospitals. It is largely unknown how these regulations affected patient outcomes, the quality of physician training, and how programs responded to improve or maintain patient outcomes and the quality of residency training. In this study, we will examine how residency programs and hospitals responded to the duty hour reform and how these behavioral responses determined which residency programs and hospitals experienced relative improvements or worsening in educational and clinical outcomes, important questions given that tens of millions of Americans receive care from the physicians in training who were the subject of the duty hour regulation.
Funding Period: ----------------2009 - ---------------2012-
more information: NIH RePORT

Top Publications

  1. pmc To leave or to lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified?
    Julia E Szymczak
    University of Pennsylvania, Philadelphia, PA 19104, USA
    Milbank Q 88:350-81. 2010
  2. pmc Internal medicine trainees' views of training adequacy and duty hours restrictions in 2009
    Judy A Shea
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 6021, USA
    Acad Med 87:889-94. 2012
  3. pmc Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors
    Judy A Shea
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 6021, USA
    Acad Med 87:895-903. 2012
  4. pmc Training for efficiency: work, time, and systems-based practice in medical residency
    Julia E Szymczak
    University of Pennsylvania, Department of Sociology, Philadelphia, PA 19104, USA
    J Health Soc Behav 53:344-58. 2012
  5. pmc Teaching hospital five-year mortality trends in the wake of duty hour reforms
    Kevin G Volpp
    Center for Health Equity Research and Promotion, Veteran s Administration Hospital, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 6021, USA
    J Gen Intern Med 28:1048-55. 2013
  6. pmc The Hospital Compare mortality model and the volume-outcome relationship
    Jeffrey H Silber
    Center for Outcomes Research, 3535 Market Street, Suite 1029, Philadelphia, PA 19104, USA
    Health Serv Res 45:1148-67. 2010
  7. pmc Sleep, supervision, education, and service: views of junior and senior residents
    Karen R Borman
    Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania 19001, USA
    J Surg Educ 68:495-501. 2011

Scientific Experts

  • J H Silber
  • Karen R Borman
  • Kevin G Volpp
  • Judy A Shea
  • Julia E Szymczak
  • Kamal M F Itani
  • Charles L Bosk
  • Dylan S Small
  • Orit Even-Shoshan
  • Jingsan Zhu
  • Amy K Rosen
  • Lisa Bellini
  • Yanli Wang
  • Patrick S Romano
  • Michael J Halenar
  • Sophia Korovaichuk
  • Arlene Weissman
  • Karen M Chacko
  • Stephanie A Call
  • Furman S McDonald
  • Saima Chaudhry
  • Michael Adams
  • Lisa L Willett
  • Sean McKinney
  • Vineet M Arora
  • Joanna Veazey Brooks

Detail Information

Publications7

  1. pmc To leave or to lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified?
    Julia E Szymczak
    University of Pennsylvania, Philadelphia, PA 19104, USA
    Milbank Q 88:350-81. 2010
    ..In this qualitative study, we explore how medical and surgical residents perceive and respond to DHR by examining the "local" organizational culture in which their work is embedded...
  2. pmc Internal medicine trainees' views of training adequacy and duty hours restrictions in 2009
    Judy A Shea
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 6021, USA
    Acad Med 87:889-94. 2012
    ....
  3. pmc Anticipated consequences of the 2011 duty hours standards: views of internal medicine and surgery program directors
    Judy A Shea
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 6021, USA
    Acad Med 87:895-903. 2012
    ..To assess internal medicine (IM) and surgery program directors' views of the likely effects of the 2011 Accreditation Council for Graduate Medical Education duty hours regulations...
  4. pmc Training for efficiency: work, time, and systems-based practice in medical residency
    Julia E Szymczak
    University of Pennsylvania, Department of Sociology, Philadelphia, PA 19104, USA
    J Health Soc Behav 53:344-58. 2012
    ..We found that residents struggle to be efficient in the face of seemingly intractable "systems" problems. Residents work around these problems, and in doing so develop a tolerance for organizational vulnerabilities...
  5. pmc Teaching hospital five-year mortality trends in the wake of duty hour reforms
    Kevin G Volpp
    Center for Health Equity Research and Promotion, Veteran s Administration Hospital, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 6021, USA
    J Gen Intern Med 28:1048-55. 2013
    ..While previous studies showed no systematic impacts in the first 2 years post-reform, the impact on mortality in subsequent years has not been examined...
  6. pmc The Hospital Compare mortality model and the volume-outcome relationship
    Jeffrey H Silber
    Center for Outcomes Research, 3535 Market Street, Suite 1029, Philadelphia, PA 19104, USA
    Health Serv Res 45:1148-67. 2010
    ..We ask whether Medicare's Hospital Compare random effects model correctly assesses acute myocardial infarction (AMI) hospital mortality rates when there is a volume-outcome relationship...
  7. pmc Sleep, supervision, education, and service: views of junior and senior residents
    Karen R Borman
    Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania 19001, USA
    J Surg Educ 68:495-501. 2011
    ..To assess sleep time and views about faculty supervision and educational activities of residents training only under 2003 duty hours standards...