American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Resident Satisfaction Rises with Flexible Duty-Hours

OCTOBER 29, 2019
Clinical Congress Daily Highlights, Tuesday First Edition


Over time, flexible duty-hour policies resulted in improvement in resident satisfaction and other outcomes measures, report researchers who extended a 2015 study through 2018.

In 2015, the Flexibility in Duty-Hour Requirements for Surgical Trainees (FIRST) trial showed that after one year, there was no significant difference in resident satisfaction between flexible and standard duty-hour policies. Yet the broader results of that trial, including survey results showing a strong preference for flexible duty-hours, led the Accreditation Council for Graduate Medical Education (ACGME) to adopt flexible duty-hour policies.

Rhami Khorfan, MD, Northwestern University, Chicago, IL, presented data expanding on the initial study. The objectives were to determine the effects of multiple years of flexible duty-hour policies on duty-hour violations, resident satisfaction, continuity of care, and perceived negative effects.

Dr. Khorfan’s team analyzed survey results from about 3,800 general surgery residents at 117 programs that participated in the FIRST Trial. Over time, residents in the flexible arm demonstrated fewer duty-hour violations, increased satisfaction with flexibility, less frequent reports of negative effects on personal factors, and fewer lapses in continuity. However, there was no statistical difference between the two arms in duty-hour violations or resident satisfaction with overall education or well-being.

These results expand on previous findings by demonstrating that after cumulative time under flexible duty-hours, residents report a high rate of satisfaction. At the same time, there were no detrimental effects on duty-hour violations or well-being.

One limitation of this study is that it did not have access to patient safety and outcome data. Therefore, no direct conclusion could be drawn on how multiple years of flexible duty-hours translate to potential improvements in patient care. Dr. Khorfan noted that the closest approximation to patient outcomes available from their data is continuity of care.

Additional Information:
The Scientific Forum, Surgical Education IV – Cumulative Effect of Flexible Duty Hour Policies on Resident Outcomes: Long-Term Follow-Up Results from the FIRST Trial, was held Tuesday, October 29 at the American College of Surgeons Clinical Congress 2019 in San Francisco (program, webcast and audio information).