Revisiting the rotating call schedule in less than 80 hours per week

Area of Science:

• Surgical Education
• Resident Well-being
• Healthcare Administration

Background:

• Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions necessitate adjustments in surgical residency programs.
• Night-float (NF) systems were adopted but led to resident dissatisfaction.
• A transition to a rotating junior resident call model (Q4) was implemented to address these concerns.

Purpose of the Study:

• To prospectively evaluate the impact of transitioning from NF to Q4 call systems.
• To assess changes in resident education, morale, and quality of life.
• To measure compliance with ACGME work rules and American Board of Surgery In-Training Examination (ABSITE) scores.

Main Methods:

• Residents completed surveys using a 5-point Likert scale before and after the call system transition.
• Data on ACGME work rule compliance, ABSITE scores, and operative case logs were compared between the NF and Q4 systems.
• Statistical analysis included the Wilcoxon rank-sum test for survey responses.

Main Results:

• Residents reported significantly higher morale and engagement with Q4 compared to NF (p = 0.001).
• Operative experience for first-year residents remained consistent across both call systems (p = 0.51).
• Excellent compliance with ACGME work rules was maintained, with minimal violations in both systems.

Conclusions:

• Transitioning from NF to Q4 call systems preserves educational opportunities and ACGME work rule compliance.
• Resident morale and engagement are significantly improved with a Q4 rotating call schedule.
• The Q4 model is a preferred alternative for surgical residency programs seeking to balance resident well-being and training requirements.