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Understanding the Multidimensional Effects of Resident Duty Hours Restrictions: A Thematic Analysis of Published
Katharine S Devitt1, Michael J Kim, Lesley Gotlib Conn
1K.S. Devitt is research associate, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. M.J. Kim is a PhD student in medical education and research fellow, Wilson Centre, University of Toronto, Toronto, Ontario, Canada. L. Gotlib Conn is associate scientist, Sunnybrook Research Institute, Toronto, Ontario, Canada. F.C. Wright is professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.-A. Moulton is associate professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. I. Keshet is clinical fellow, Neurocritical Care, Department of Neurosurgery, North Shore University Hospital, Manhasset, New York. N. Ahmed is residency training program director, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Purpose:
Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery.
Method:
The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines. A thematic analysis approach guided data extraction. Contextual data were abstracted from the included articles to aid in framing the identified themes.
Results:
Of 1,482 identified articles, 214 were included in the review. Most were from authors in the United States (144; 67%) and focused on the 80-hour workweek (164; 77%). The emerging themes were organized into three overarching categories: (1) impact of the RDH restrictions, (2) surgery has its own unique culture, and (3) strategies going forward. Published opinions suggested that RDH restrictions alone are insufficient to achieve the desired outcomes and that careful consideration of the surgical training model is needed to maintain the integrity of educational outcomes.
Conclusions:
Opinions from the surgical community highlight the complexity of issues surrounding the RDH restrictions and suggest that recent changes are not achieving all the desired outcomes and have resulted in unintended outcomes. From the perceptions of the various stakeholders in surgical education studied, areas for new policies were identified.
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