Flexible work hour schedules for surgeons in training may be beneficial for both patients and residents, preventing disruptions in patient care and surgical education, directors of general surgery residency programmes believe. These perceptions are the findings of a survey conducted in conjunction with the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, a randomized controlled study that examined the effects of allowing surgical residents to work more flexible hours than currently required by the Accreditation Council for Graduate Medical Education (ACGME). The survey collected observations from directors of 59 general surgery residency programmes that adhered to the “Standard Policy” regarding resident work hours and those of 58 programs that tested a “Flexible Policy.” Standard Policy, which was established by the ACGME in 2011, places additional restrictions on maximum shift length for first year residents and increases the required time off following overnight call shifts for residents beyond the initial duty hour. Flexible Policy relaxes these requirements. In the Flexible Policy arm, nearly all directors said that residents used the flexible time to engage in direct patient care--stabilizing critically ill patients or completing operations they had started (100 percent of directors), assisting with transitions in care (97 percent), or operating on a patient on their clinical service or performing an uncommon or complex operation that was important to residents’ development as a surgeon (95 percent). Around 69 percent of these program directors also felt that flexible duty hours had a positive effect on patient safety. In contrast, none of the programme directors in the Standard Policy arm believed that standard duty hours had a positive effect on patient safety, and 14 percent felt that current duty hour restrictions had a negative effect on patient safety. Most of all the program directors felt that a shift to flexible duty hours would positively affect patient safety (72 percent), continuity of care (94 percent), quality of resident education (84 percent), and resident well-being (56 percent). “Findings from this survey of program directors are consistent with the sentiments of residents who participated in the FIRST Trial, which showed that there was no difference in patient safety or outcomes when surgical residents had flexible working hours,” said lead study investigator Dr. Anthony Yang, assistant professor of surgery at Northwestern University Feinberg School of Medicine. “Residency program directors in this survey in fact believed that flexible duty hours were likely to improve patient safety,” Yang added. The current ACGME policy on duty hours has been questioned in recent years, despite being created to minimize concerns about patient safety and residents’ well-being. In previous surveys, programme directors raised concerns that the work hour restrictions prevent residents from witnessing the development and clinical course of a patient’s illness, reduce residents’ preparedness for assuming senior clinical roles, and limit residents’ ability to achieve specialty-specific competency goals. “Because residents must adhere to a rigid work schedule, they may have to leave the hospital even when they are still actively caring for patients. Such work hour restrictions may interfere with their ability to care for patients through the entire inpatient episode and to fully participate in operations on patients they have evaluated to the point where they often have to leave in the middle of an operation,” Yang said. While implemented with good intentions, restrictions on duty hours of residents limit residents with regard to caring for patients as well as their education, Yang explained. Giving residents flexibility is not ruinous and may even help patients and residents as how programme directors see it. One director said this flexibility provides patients with greater continuity of care and allows residents to take on a greater commitment to their patients, while another mentioned it allows residents to make the patient, rather than the clock, their prime focus. Source
