title: Effects of a twenty-four hour call period on resident performance during simulated endoscopic sinus surgery in an accreditation council for graduate medical education-compliant training program.
abstract: OBJECTIVE
  Since the early 1990s, extended resident work hours have undergone increasing scrutiny. Although previous studies have demonstrated conflicting results regarding cognitive decline secondary to fatigue, few studies have specifically examined the effects of fatigue on surgical performance. No previous studies have examined resident performance under current Accreditation Council for Graduate Medical Education (ACGME) work-hour guidelines that limit residents to an average number of work hours of 80 hours per week. The study sought to determine whether an endoscopic sinus surgery simulator (ES3) measured performance changes before and after a 24-hour on-call period in residents following mandated work-hour limitations.
  
  
  METHODS
  Case control, crossover trial at a Level I trauma center.
  
  
  METHODS
  Eight general surgical residents were trained on the novice mode of the ES3. These residents were then tested twice both before and after on-call duties. Performance and hazard scores were compared using a paired t test.
  
  
  RESULTS
  No statistically significant change in the number of errors, time to task completion, or overall performance was identified in the study between the precall and postcall groups. There was a trend toward improved speed at the expense of accuracy in the postcall group. Postcall score between the two trials improved, on average, by 3.3 (P = .045).
  
  
  CONCLUSIONS
  In the study of residents following current ACGME work-hour mandates, there was no diminution in performance before and after a 24-hour on-call period. There was a trend toward improved speed at the expense of accuracy. Furthermore, repetition on the ES3 in the postcall period can result in improved ES3 proficiency.
authors.affiliation: Division of Otolaryngology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Jakubowicz
authors.forename: Erin M
authors.initials: EM
authors.lastname: Price
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Glassman
authors.forename: Anthony J G
authors.initials: AJ
authors.lastname: Gallagher
authors.forename: Neil
authors.initials: N
authors.lastname: Mandava
authors.forename: Walter P
authors.initials: WP
authors.lastname: Ralph
authors.forename: Marvin P
authors.initials: MP
authors.lastname: Fried
mesh_terms: D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate; D004724:Endoscopy; D005221:Fatigue; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D012892:Sleep Deprivation; D014584:User-Computer Interface; D016526:Workload