Background: The Baylor College of Medicine Multi-institutional Integrated Plastic Surgery Program has instituted a resident duty work-hours policy since July 1, 2002 consistent with the ACGME guidelines. Outcomes data is needed to facilitate continuous improvements to plastic surgical residency training while maintaining high quality patient care. To assess the impact of this policy intervention on resident education as measured through the six general competencies and patient/resident safety, the investigators surveyed all categorical plastic surgery residents six-months after implementation of this policy.

Study Design: The categorical plastic surgery residents at the Baylor College of Medicine Multi-institutional Integrated Plastic Surgery Program completed a 68-itemized survey on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). Residents were asked to rate multiple parameters including statements on patient care and clinical/operative duties, resident education, resident quality of life, and resident perceptions on this policy. The sample size was N=12 (PGY3-6) with a 100% response rate. Univariate and bivariate statistical analysis was conducted with SPSS Version 10.0 statistical software.

Results: Descriptive statistics indicated higher percentages of agreement on a majority of statements in three categories including patient care and clinical/operative duties, academic duties, and resident quality of life. However, residents identified a negative impact of this policy through an increase in cross-coverage responsibilities, and they perceived that faculty negatively viewed their unavailability post-call. Using interquartile deviation, highest level of consensus among the residents were found in positive statements addressing resident alertness (both in and out of the operative environment); time to read/prepare for cases/conferences; efficacy of the didactic curriculum; and overall satisfaction of this policy for surgery resident education. Residents also felt that their patients favored this work-hours policy. In addition, there was high-consensus that this policy improves overall patient care. On the other hand, no consensus was achieved regarding perceptions on overall weekly operative experience.

Conclusions: Plastic surgery residents perceived that the reduction of resident work hours through adherence to the ACGME guidelines have beneficial effects on patient care and clinical/operative duties, academic duties, and resident quality of life. However, residents felt that these benefits may increase cross-coverage workloads. Furthermore, residents were concerned about faculty perception of their changes in post-call duties. Further investigation is warranted to evaluate faculty perceptions of this work-hour policy. In contrast to prior published findings, our results indicate that residents do not believe that this policy negatively impacts continuity of patient care. In fact, our findings suggest that adherence to this policy improves patient care on multiple levels. Since the sample size is small, generalizability of the study is limited. Further large-scale and longitudinal research design and analysis should be considered in future studies to better assess the impact of the ACGME resident duty work-hours policy on plastic surgery resident education.
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