Do different hours mean better results for surgeons?

Robert Yu, MD, is a surgeon training in his residency at Carle. While he put in long hours in med school, he is also putting in long hours as a resident. He always has to guard against fatigue and be alert in the operating room. But, Dr. Yu says he doesn’t mind being on duty for 24 hours, and he has learned the valuable lesson of pacing himself for his entire shift.

Carle surgical residents participated in a national project to determine if flexible working hours helped or hurt their experience and, more importantly, patient care. According to research results called the FIRST Trial; working less restrictive hours did not affect patient care and actually improved the residents’ experience.

“Current Accreditation Council for Graduate Medical Education duty hour rules mandate that surgical residents work less than 80 hours per week, with at least one day off per week. Shifts for residents cannot be longer than 24 hours, or 16 hours for first-year residents, with ten hours off between shifts,” said Michelle Olson, MD, director, General Surgery Residency Program.

The FIRST Trial gave residents more flexibility. Dr. Olson explained, “Our program was part of the flexible-hours group. We continued to follow the 80 hours maximum and 1 day off per week rules, but the residents, even the interns, could stay beyond 24 hours for continuity of patient care. Despite the flexible rules, on average, residents worked the same number of hours per week as they had before, while missing fewer clinical opportunities.”
“Having the longer hours enabled me to spend more time in the hospital and take better care of my patients,” Dr. Yu said. 

The initial study ran from July 1, 2014 to June 30, 2015. Programs were asked to continue with the flexible hours scheduling through June 30, 2016 for additional data. 

Dr. Yu added that he had a more hands-on experience under the flexible hours. “My colleagues and I noticed that with the old duty hours, we were not able to operate more. We had fewer hours in the hospital because we would take overnight calls.”

“I learned more thanks to flexible hours.”

Dr. Olson (pictured left) explained the impact of the findings, “Everyone agrees that there should be limits to the number of resident duty hours. We realize that fatigue adversely affects learning and could have effects on patient care; however, decreasing the length of work shifts also increases the number of patient handoffs. More handoffs could impact patient care in missed critical information. ”

The change in hours gave residents a taste of reality. “Being a surgeon is not a 9 to 5 job,” Olson said. “Not only do patients come to the emergency room with surgical problems at all hours of the day and night; hospitalized patients also have needs that require physician intervention at inconvenient times. There are no duty hour limits for practicing surgeons. Surgeons must be able to recognize and manage their own fatigue and they develop this skill during residency. In a residency program, trainees are supervised and have the attending staff as a back-up at all times. It’s a safe place to build stamina and to prepare for the realities of independent practice.”