Duty Hour Reporting: Conflicting Values in Professionalism

Area of Science:

• Medical Education
• Graduate Medical Training
• Professionalism in Medicine

Background:

• Duty hour limits in medical residency programs create tension between patient care needs and regulatory compliance.
• This conflict may compromise the truthfulness of residents' duty hour reporting.

Purpose of the Study:

• To investigate the underlying reasons why residents falsify their duty hour reports.
• To explore the frequency of violations and residents' awareness of options for extended patient care hours.

Main Methods:

• A survey was administered to residents at a single sponsoring institution.
• Descriptive statistics and linear regression were used to analyze reasons for noncompliance, falsification, and its correlation with training year.

Main Results:

• The survey achieved an 88% response rate (572/650 residents).
• Key reasons for duty hour violations included patient volume and complexity.
• Junior residents were more likely to falsify reports, primarily due to concerns about ACGME program violations and fear of punishment.

Conclusions:

• Falsification of duty hour data is driven by resident anxiety over ACGME repercussions.
• Recommendations include educating residents on professionalism in reporting and implementing a no-blame, systems-based approach by the ACGME.
• Allowing junior residents to extend hours for complex patient care is suggested.