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The resident call points system: A quantitative framework for equitable workload distribution in neurosurgical
Temitope M Adegbenro1, Ali H Bangash1, Rose Fluss1
1Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Objective:
Workload equity is a factor critical in maintaining resident well-being but remains inadequately addressed via duty-hour restrictions alone. We evaluated a Resident Call Points (RCP) System's effectiveness in promoting equity in residency training by reducing disparities in workload variance and improving duty hour compliance.
Methods:
A single-site retrospective analysis of the call burden of 94 junior neurosurgical residents over 22 years was conducted. The RCP system is a weighted call-allocation framework used to measure and balance resident call burden quantitatively by assigned shifts a specific point value. Equity of workload distribution and overall call burden were the primary outcomes. Equity was measured using the variance (statistical spread) of RCPs while call burden was measured with the median RCP. Two groups: G1; pre-RCP period (2003-2011), and G2; post-RCP period (2012-2025) were analyzed and compared based on median RCP, RCP variance, and accredited survey-reported duty-hour compliance.
Results:
After implementation of the RCP system, overall variance significantly decreased in G2 compared to G1, indicating greater equity in workload distribution. RCP median was significantly increased between G2 and G1 for PGY-3 only, indicating an increased workload for that specific training year. Sub-analysis did not reveal differences in workload between PGY-2 and PGY-3 in G2. Reported duty-hour violations decreased from 34% (18/53) to 11.1% (10/90) post-implementation (p < 0.001).
Conclusion:
The RCP system likely promotes equity in the call schedule by significantly reducing workload variance and is associated with improved resident compliance with duty-hours. By promoting fairness and addressing workload equity, the RCP system may provide a reproducible framework for improving duty-hour compliance in graduate medical education.
