The Effect of Duty Hour Regulation on Resident Surgical Case Volume in Otolaryngology

Abstract

Objectives:

Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and to analyze trends in surgical case volume for each of the Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996-2011.

Methods:

Operative logs were obtained from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996-2011. Key indicator volumes before and after resident duty hour regulations (2003) were compared. A paired t-test was performed to evaluate the overall difference in operative volume. The Wilcoxon signed rank test evaluated differences between individual procedures per time period. Linear association of the average volume of each key indicator per year was performed using linear regression.

Results:

The average total number of key indicator cases per graduating resident was 441 in 1996-2003 compared to 500 cases in 2004-2011, and the average number of key indicator cases (total key indicator cases/number of key indicators) was 31.5 in 1996-2003 compared to 36.2 in 2004-2011 (P = 0.0012). The linear association for the change in average number of key indicator cases per year was not statistically significant (P = 0.1990). Sub-analysis of individual key indicators showed a statistically significant (P < 0.05) increase in volume between pre- and post-duty hour regulation for bronchoscopy, ethmoidectomy, mastoidectomy, parotidectomy, and thyroid/parathyroidectomy and a decrease in flaps and stapes/ossiculoplasty.

Conclusions:

Implementation of the 2003 duty hour regulations has not reduced the total volume of key indicator cases for graduating otolaryngology residents. Overall and many specific key indicator operative volumes have increased.