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Attending physician feedback significantly influences resident decisions to take postcall days off, impacting compliance with Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs). Improving safety culture can enhance adherence to these important patient safety guidelines.

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Area of Science:

  • Medical Education
  • Patient Safety
  • Resident Well-being

Background:

  • Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs) aim to enhance patient safety by mitigating resident fatigue.
  • Adherence to ACGME WHRs is inconsistent across institutions.

Purpose of the Study:

  • To ascertain the factors influencing residents' decisions regarding taking postcall days (PCDs) off, in alignment with ACGME WHRs.
  • To quantify the impact of various factors on resident choices to utilize PCDs.

Main Methods:

  • A survey was distributed to 433 residents at a university in 2019, incorporating demographic questions and a Discrete Choice Experiment.
  • The Discrete Choice Experiment was designed to evaluate the influences on residents' decisions to take a PCD.

Main Results:

  • Positive attending physician feedback on PCD use was the strongest positive influencer (27.3% probability increase).
  • Negative feedback regarding PCD use (14.3% decrease) and continuity of care concerns (10.8% decrease) were significant deterrents.
  • Chief resident comments about resident fatigue and lack of attending feedback also influenced decisions.

Conclusions:

  • Attending physician feedback is the paramount factor in residents' decisions to take PCDs.
  • Enhancing compliance with WHRs may be achieved by cultivating a supportive residency program safety culture that encourages PCD utilization.