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James Coverdill, William Finlay University of Georgia, Athens, GA

How Surgical Faculty and Residents Assess the First Year of the ACGME Duty-Hour Restrictions Results of a Multi-Institutional Study. James Coverdill, William Finlay University of Georgia, Athens, GA John D. Mellinger, Gina L. Adrales Medical College of Georgia, Augusta, GA

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James Coverdill, William Finlay University of Georgia, Athens, GA

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  1. How Surgical Faculty and Residents Assess the First Year of the ACGME Duty-Hour RestrictionsResults of a Multi-Institutional Study

  2. James Coverdill, William Finlay University of Georgia, Athens, GA John D. Mellinger, Gina L. Adrales Medical College of Georgia, Augusta, GA Kimberly D. Anderson University of Texas, Houston, TX Bruce W. Bonnell Michigan State University, Grand Rapids, MI Joseph B. Cofer University of Tennessee, Chattanooga, TN Douglas Dorner Iowa Health, Des Moines, IA Carl Haisch East Carolina University, Greenville, NC Kristi L. Harold Mayo Clinic, Scottsdale, AZ Paula Termuhlen Wright State University, Dayton, OH Alexandra L. B. Webb, Emory University, Atlanta, GA Acknowledgements: Mary Anne Park, Medical College of Georgia; Jim Bason, University of Georgia, Daniel Hall, University of Georgia

  3. 1987 NY ad hoc Advisory committee established to evaluate GME 1988-99 Baldwin et al survey: average surgical intern hours 102/wk 1984 Libby Zion wrongful death suit filed 2003 ACGME “80-hour/week” restriction 1995 3 doctors found negligent in Libby Zion case 1999 NIM report 44-98K deaths/yr due to medical error 1989 NY “405” regulations

  4. The Doctor Is Out Some fourteen years after the Libby Zion case changed the way hospitals are run—and medicine is taught—it’s clear that residents are getting more sleep. But many doctors say that patients—and even the residents—are being shortchanged. November 3, 2003 New Yorkmetro.com

  5. Objective • Examine the views of residents and faculty regarding the duty-hour restrictions (DHR) within a multi-institutional study • Determine whether faculty and resident assessments diverge • Explore factors that influence the differences in views among faculty and residents

  6. Methods • 9 general surgery residencies in 8 states • 5 traditional academic programs • 4 non-academic programs • 2 community programs • 2 “hybrid” programs • Surgical residents, PGY-2 or greater • Faculty beyond their first year of practice • IRB approval at the coordinating centers (UGA, MCG) and the local boards

  7. Methods • Questionnaire surveys were distributed in June-August 2004 • Items critiqued by director of Survey Research Center, University of Georgia • 4-point likert responses (1=strongly agree, 4=strongly disagree) • 37-item resident survey • 39-item faculty survey • 21 items common to both surveys were analyzed for comparison • Mean differences were examined with two-tailed t-tests (p<.05)

  8. Results • Response rates • 63% for faculty (N=146) • 58% for residents (N=113) • Respondents predominantly male • 85.6% of faculty • 70.8% of residents • Program type • Academic 49% residents, 47% faculty respondents • Non-academic 51% residents, 53% faculty

  9. * * * * * * Residency Program and Training *Mean responses significantly different, p<.05

  10. * * * * * * Patient Care *Mean responses significantly different, p<.05

  11. * * * * Quality of Life/Overall Assessment *Mean responses significantly different, p<.05

  12. Results • Few differences were found among faculty responder groups • AGE Deviations from resident responses were significantly different on only 3 of 21 items. Older faculty were more aligned with residents than younger faculty • CLINICAL DUTIES 4 of 21 items significantly different.No consistent differences between clinical faculty and research faculty views • GENDER No significant difference among 21 items • No differences based on program type • There were significant differences based on resident gender. Mean responses on 11 of 21 items were significantly different.

  13. * * * * Gender DifferencesResident Program and Training *Mean responses between male and female residents significantly different, p<.05

  14. * * * * * Gender DifferencesPatient Care *Mean responses between male and female residents significantly different, p<.05

  15. * * Gender DifferencesOverall Assessment of DHR *Mean responses between male and female residents significantly different, p<.05

  16. Conclusions • Apparent tension between support of DHR and concern about their consequences • Majority of residents and faculty believe that lack of familiarity, not fatigue, are the major cause of medical error • Significant divergence between residents and faculty regarding DHR effects on training and patient care; Residents view DHR more favorably

  17. Conclusions • Faculty age, faculty gender, program type did not systematically factor into the differences between faculty and resident views • Resident gender was a strong and consistent factor in the faculty-resident gap • This may lead to discord in residency programs and create tension between female residents and faculty

  18. Conclusions • Limitations • Relies on subjective assessments • Subgroup sizes fairly small (Faculty gender, program type) • Could not evaluate reliably differences due to level of resident training • Gender issues in regard to DHR should be an area of more intensive investigation

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