Effect of Work Hour Restriction on Residents’ Case Volume

Abstract

Objective: 1) To determine the effect of the Accreditation Council for Graduate Medical Education (ACGME) 80-hour work restriction on the total number of cases of graduating residents. 2) To determine the effect of the ACGME 80-hour work restriction on the total number of key indicator cases of the graduating residents.

Method: The ACGME national data reports of case logs for graduating residents from 2004-2011 were analyzed. Linear regression was used to evaluate for changes in total case numbers over time. Separate models were generated for total case volume, ACGME categories for resident participation (surgeon, assistant, supervisor), and ACGME key indicator categories.

Results: A statistically significant increase in total case volume was observed over the study period, with graduating residents on average performing 25.8 more cases per study year (95% CI = 6.5 to 44.9, P = .018). This increase is primarily accounted for by an increase in the number of cases categorized as surgeon, with 19.8 more cases per study year (95% CI = 5.8 to 33.7, P = .015). An increase of 4.1 cases per study year in the key indicator category of Head and Neck was observed (95% CI = 1.6 to 6.5, P = .008).

Conclusion: Despite implementation of the 80-hour duty restriction, case logs of graduating residents demonstrated an increase in case volume over calendar time. Further research will be necessary to determine if this finding reflects improved efficiencies in training programs or redistribution of resident activities away from other educational opportunities.