The effect of resident work hour regulations on orthopaedic surgical education

Accreditation Council for Graduate Medical Education (ACGME) resident work hour regulations have been effective since July 2003. Several areas affected by these changes have been identified, including surgical education. In the current study, the authors evaluated the impact of these changes on surgical education at a two-person-per-year orthopaedic training program. Operative case experiences of PGY 2 and 3 residents during the academic years 2002-2003 and 2003-2004 were compared utilizing ACGME case logs. A data entry log was also distributed to examine subjectively the effects on operative case load. ACGME data showed that PGY 2 and 3 residents performed 21.5% fewer cases between years. The average number of cases per rotation decreased by 20.44% (p =.009, paired t-test). Subjective results also showed a decrease, with an average of 10.8% of cases missed per resident. This study shows that residents who have begun training post-80-hour work week will do fewer procedures. This may result in a decreased level of skill, or it may shift operative experience to the senior resident years, prolonging the learning curve. Regardless, future analysis must be done to determine the full impact on training of the orthopaedic resident.