title: Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study.
abstract: BACKGROUND
  The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our published data from the preceding year indicated significant impairment in psychologic well-being among surgery residents. The purpose of this study was to determine whether psychologic well-being and academic performance of surgery residents improved after inception of the 80-hour workweek.
  
  
  METHODS
  A single-blinded survey of general surgery residents (n=130) across 4 US training programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom Checklist-90-R and Perceived Stress Scale) and the American Board of Surgery In-Training Examination; comparison was done with preceding year and societal data. Primary outcomes were "psychologic distress" and "perceived stress." Secondary outcomes were "somatization," "depression," "anxiety," "interpersonal sensitivity," "hostility," "obsessive-compulsive behavior," "phobic anxiety," "paranoid ideation," "psychoticism." and "academic performance." The impact of demographic variables was assessed.
  
  
  RESULTS
  Mean psychologic distress improved from the preceding year (P < .01) but remained elevated, compared with societal norms (P < .001). The proportion of residents meeting the criteria for clinical psychologic distress (>or=90th percentile) decreased from 38% before, to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P < .0001) without improvement from the preceding year. Overall academic performance was unchanged. Previously elevated secondary psychologic outcomes improved after July 2003 (P < .05), although obsessive-compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to normalize. Male gender and single status were independent risk factors for psychologic distress.
  
  
  CONCLUSIONS
  Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents. The perception of stress and academic performance remains unchanged.
authors.affiliation: Department of Surgery, Boston VA Health Care System, MA, USA.
authors.forename: S Mahmood
authors.initials: SM
authors.lastname: Zaré
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Galanko
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Behrns
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Sieff
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Boyle
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.forename: Stephen R T
authors.initials: SR
authors.lastname: Evans
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000517:prevention & control / Q000523:psychology; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000517:prevention & control / Q000523:psychology*; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000523:psychology*; D010561:Personnel Staffing and Scheduling; D014940:Work Schedule Tolerance / Q000523:psychology*