Residents' perception of the impact of the Bell Commission in oral surgery training: an initial study

In 1989, the New York State Legislature enacted New York State Code 405 (Bell Commission) in response to the death of Libby Zion at Lincoln Medical and Mental Health Center (Bronx, NY). The resultant limitations imposed on resident work hours have been the focus of much debate in medical literature, but their impact on the training of oral and maxillofacial surgery (OMFS) residents has remained relatively unexplored. The purpose of this study was to evaluate the opinion of OMFS residents toward the benefits of work hour restrictions. We asked residents how work hour restrictions affected their ability to provide care safely and efficiently and the quality of their surgical training. We also aimed to estimate the amount of their scheduled off-time that residents used for sleep.

A 12-item questionnaire was forwarded to all available residents and interns in the 17 OMFS training programs in New York State. A total of 36 surveys were returned.

The majority of respondents felt that their program adhered fairly well to the guidelines of the Bell Commission and that it had a positive effect on the quality and efficiency in which they provided patient care. Most also felt that the Bell Commission guidelines had a positive effect on the quality of their residency. However, senior residents felt that the Bell Commission did not have as positive of an impact on their ability to provide care safely or efficiently as junior residents. Similarly, senior residents felt that the quality of their residency had not been as greatly improved by the Bell Commission as did junior residents, and used a lower percentage of their time off duty on actual sleep.

This preliminary study indicates that most OMFS residents perceive that the Bell Commission guidelines have a positive impact on their residency training and on patient care. We recommend further studies to evaluate the effects of the Bell Commission on OMFS training. Additionally, the perception of OMFS faculty can be appraised in future studies. However, the limitations of this study include recall bias of the surveyed residents and responder bias (including fear of reprisal in reporting details that might otherwise be considered by training programs to be confidential).