The resident call points system: A quantitative framework for equitable workload distribution in neurosurgical...

Area of Science:

• Medical Education
• Neurosurgery Training
• Workload Management

Background:

• Workload equity is crucial for resident well-being, yet current duty-hour restrictions are insufficient.
• Disparities in workload distribution negatively impact resident well-being.
• Objective measurement of call burden is needed to ensure equitable training.

Purpose of the Study:

• To evaluate the effectiveness of a Resident Call Points (RCP) System in promoting workload equity.
• To assess the RCP System's impact on reducing disparities in workload variance.
• To determine if the RCP System improves duty hour compliance among residents.

Main Methods:

• Retrospective analysis of call burden for 94 junior neurosurgical residents over 22 years.
• Implementation of a weighted call-allocation framework (RCP System) to quantify and balance resident call burden.
• Comparison of workload equity (RCP variance) and call burden (median RCP) between pre-RCP (G1) and post-RCP (G2) periods, alongside duty-hour compliance data.

Main Results:

• The RCP system significantly decreased workload variance, indicating improved equity in call distribution (G2 vs. G1).
• Reported duty-hour violations decreased from 34% to 11.1% post-implementation (p < 0.001).
• While overall variance decreased, the median RCP increased for PGY-3 residents, suggesting a higher workload for this specific year.

Conclusions:

• The RCP system effectively promotes equity in call schedules by reducing workload variance.
• The RCP system is associated with improved resident compliance with duty hours.
• This system offers a reproducible framework for enhancing fairness and compliance in graduate medical education.