The 80-hour work week: will we have less-experienced graduating surgeons?
OBJECTIVE
Our primary concern when modifying the Mount Carmel Medical Center surgical residency to comply with the "80-hour work week" was the effect on operative experience. Our goal was to measure the impact that work-hour restrictions have on operative volumes and to evaluate the potential benefit of a night rotation to minimize the number of "lost operations."


METHODS
Categorical surgical residents (PGY I-IV) recorded missed surgical procedures on post-call days from September 1, 2002 to March 31, 2004. The data collection is split between the pre-night rotation (September 1, 2002 to March 31, 2003) and post-night rotation (April 1, 2003 to March 31, 2004) periods. The post-night rotation period is further divided to account for the end of the academic year. Previous graduate operative logs were reviewed for comparison.


METHODS
Mount Carmel Health System is a tertiary referral, community-based hospital in Columbus, Ohio.


METHODS
Categorical general surgery residents (Postgraduate Years I to V).


RESULTS
In the 7-month period, extending from September 1, 2002 to March 31, 2003, the average number of missed cases for successive levels was PGY I: 21, PGY II: 31, PGY III: 26, and PGY IV: 40. From April 1, 2003 to June 30, 2003, the average number of missed cases for successive levels was PGY I: 3, PGY II: 7, PGY III: 5, and PGY IV: 6. From July 1, 2003 to March 31, 2004, the average number of missed cases for successive levels was PGY I: 34, PGY II: 8, PGY III: 14, and PGY IV: 30. Before the implementation of a night rotation, residents were projected to miss an average of 202 operations over 4 years. After implementation of a night rotation, the projected loss would drop to 107 operations over 4 years.


CONCLUSIONS
Work-hour restrictions result in a significant decrease in operative experience. This detriment can be partially alleviated with the institution of a night rotation to better regulate in-house call.
Jarman
Benjamin T
BT
Department of Surgery, Mount Carmel Health System, 793 West State Street, MSB 3rd Floor, Columbus, OH 43222, USA. benjamin_jarman@yahoo.com
Miller
Marcus R
MR
Brown
R Shane
RS
Armen
Scott B
SB
Bozaan
Anthony G
AG
Ho
George T
GT
Hartranft
Thomas H
TH
D000068:Accreditation; D002983:Clinical Competence; D003625:Data Collection; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D014940:Work Schedule Tolerance; D016526:Workload