September 1, 2002
In January 1994 the American College of Surgeons published its recommendations concerning “Surgical Residencies and the Educational Environment” (Bull Am Coll Surg, 7989-93). The following statement addresses the specific issue of residency work hours and the importance to patients of professionalism and continuity of care. It also highlights the need to improve working conditions and the educational environment for all surgical residents so that they can provide care of the highest quality to their patients. This statement was developed by the Candidate and Associate Society of the American College of Surgeons and was approved by the Board of Regents at its June 2002 meeting.
Surgical residency is first and foremost an educational experience based in direct patient care. Implicit in a residency program is the principle that all patient care provided by residents is safe and well supervised. Patients have a right to expect a healthy, alert, responsible, and responsive physician.
It is therefore inappropriate for teaching hospitals to rely upon residents to perform tasks that are not directly related to either education or patient care. These demands threaten the educational system and are a principal reason for excessive work hours. It is essential that hospitals provide sufficient support personnel to perform these non-educational tasks. It is also essential that residents are provided with appropriate support and supervision from faculty that exemplify professionalism in all aspects of patient care and interpersonal interactions. Finally, there must be comfortable facilities in which residents may rest, eat and study, and opportunities outside of the work environment for personal development.
Quality patient care, now and in the future, is dependent on quality graduate education. It is critical to monitor, modify and optimize the work environment to achieve this important goal.
Reprinted from Bulletin of the American College of Surgeons
Vol.87, No. 9, September 2002