title: Realistic expectations and leadership in the era of work hour reform.
abstract: BACKGROUND
  Work hour guidelines and core competencies were introduced to improve surgical education and are changing the landscape of surgical training. We sought to examine perceptions and attitudes regarding the impetus and impact associated with these changes.
  
  
  METHODS
  Anonymous surveys were distributed to faculty and surgeons-in-training in an Accreditation Council for Graduate Medical Education, university-based, training program.
  
  
  RESULTS
  Faculty (F, n = 30) and trainees (T, n = 30) agree that lifestyle expectations and long work hours are the principal issues facing surgical education (F = 80%, T = 56%; P = 0.03). Implementation of ACGME guidelines is perceived as NOT improving patient care or clinical experience (F = 100%, T = 90%; P = 0.03) while reducing operative experience (F = 50%, T = 70%). More faculty (>80%) than trainees (33%) are concerned that ACGME guidelines will diminish patient care experiences. Although most (F = 77%, T = 83%; P = NS) agree that hiring additional providers will improve guideline compliance, many oppose ACGME guideline implementation fearing a loss of professionalism. Although both (F = 50%, T = 47%) admonish deficient interpersonal and communication skills as the major impediment to implementing ACGME guidelines, opinions regarding implementation differ. Most faculty (67%) believe ACGME-imposed deadlines are the most influential reason; however, trainees (57%) believe guidelines should be promptly implemented to address long-awaited changes in work environment and surgical graduate medical education.
  
  
  CONCLUSIONS
  Although faculty and trainees' perception of the issues surrounding ACGME guidelines converge, perception of changes following implementation is quite divergent. For successful implementation, leadership must address prevailing attitudes and set realistic expectations. These trends have important implications for planning the future of surgical education, unifying multi-generational colleagues, and improving systems-based practice.
authors.affiliation: Department of Surgery, University of South Florida College of Medicine, Health Sciences Center, Tampa, Florida, USA. sgallagh@hsc.usf.edu
authors.forename: Scott F
authors.initials: SF
authors.lastname: Gallagher
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Krista
authors.initials: K
authors.lastname: Haines
authors.forename: Sherene
authors.initials: S
authors.lastname: Shalhub
authors.forename: P Jeff
authors.initials: PJ
authors.lastname: Fabri
authors.forename: Richard C
authors.initials: RC
authors.lastname: Karl
authors.forename: Michel M
authors.initials: MM
authors.lastname: Murr
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005180:Faculty, Medical; D013502:General Surgery / Q000193:education*; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency; D007857:Leadership; D005791:Patient Care; D011788:Quality of Life; D011795:Surveys and Questionnaires / Q000592:standards; D016526:Workload