Long-term Follow-up on the Educational Impact of ACGME Duty Hour Limits: a Pre-post Survey Study

Objective: To evaluate the long-term impact of the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hour limits on residents' perception of education.

Background: Eight years after the introduction of the ACGME duty hour limits, graduate medical education programs implemented a revised set of standards. Currently, limited data exist related to the long-term impact of the 2003 standards on resident education.

Methods: A yearly survey from 2003 to 2009 was administered to orthopedic residents in a multi-institutional program, inquiring about several aspects of the resident's educational experience, work hours, amount of sleep, fatigue and its impact, and preparedness for practice.

Results: A total of 216 responses (69%) were obtained from surveyed orthopedic residents between 2003 and 2009. There was no significant change in the average reported hours of sleep (34.6 hours per week in 2003 vs 33.7 hours per week between 2004 and 2009) despite a decrease in the mean reported number of work hours (74.5 hours in 2003 vs 66.2 hours in 2009; P = 0.046). However, a decrease in perceived fatigue and its negative impact on patient safety and quality of care was noted. The perceived sufficiency of direct clinical experience, the number of hours spent performing major procedures, and the overall satisfaction with education also decreased. Finally, the residents' sense of clinical preparedness diminished after the work hour limits were in place.

Conclusions: After the implementation of the 2003 duty hour limits, residents' perceptions of fatigue improved without any increase in the reported amount of sleep. In addition, decreased resident satisfaction with their education and a diminished sense of clinical preparedness were noted. Additional studies are needed to better understand the influence of work hours and fatigue on the outcomes of education, resident well-being, and patient care to guide the optimal design and delivery of graduate medical education.