Effect of the 30-hour work limit on resident experience and education

To evaluate the effect of the 30-hour restriction on resident operative participation and assess whether the 30-hour restriction can be extended in certain cases to enhance educational experience and continuity of care without being detrimental to the 80-hour limit.

In September 2006, we administered a 10-item Likert scale survey to 41 general surgery residents to assess their experience with the 30-hour work restriction. We also reviewed the operative reports from the busiest general surgery service in April 2003 and April 2005 to assess surgical participation before and after the 30-hour restriction.

Twenty-three (56%) residents reported missed operations each month because of the 30-hour restriction. Thirty-four (83%) reported occasions where participating in an operation would require only an additional 1-4 hours. Thirty-six (88%) residents reported a better educational experience when operating on patients whom they had evaluated and a preference to operate on patients whom they had evaluated. The operative log review revealed that in April 2003, the resident assigned to the service participated in 47 out of 134 (35%) total operations and 11 out of 30 (37%) operations beginning after noon. In April 2005, the resident assigned to the service participated in 49 out of 109 (45%) total operations and 20 out of 45 (44%) of the operations beginning after noon.

The difference in the amount of operations involving resident participation before and after the 30-hour restriction, including afternoon cases that would be most affected by the work restriction, was minimal. However, we identified occasions when the 30-hour work restriction could be extended to provide continuity of care and a better educational operative experience while maintaining weekly duty hours within the approved limit. Extensions beyond the 30 hours should be limited to providing unique and comprehensive experiences for residents where the additional time or episodes would not cause resident fatigue.