title: The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education work-hour limitations (WHLs) were implemented in July 2003. Effects on resident well-being, patient care, and education are not well understood. We investigated these effects of WHLs.
  
  
  METHODS
  Self-administered survey of internal medicine residents in a university-based residency program in Seattle, Wash. Part of this survey was identical to one completed at our institution in 2001, permitting comparison of burnout, career satisfaction, and depression before and after WHLs. We surveyed 161 internal medicine residents, with 118 respondents (response rate, 73%). We measured resident well-being using the Maslach Burnout Inventory, a validated screening questionnaire for depression, and a previously described questionnaire for career satisfaction. We developed questions about overall agreement with implementation of WHLs and effects on resident well-being, patient care, and education.
  
  
  RESULTS
  Comparison with the 2001 survey demonstrated an increase in the proportion of residents satisfied with their career (66% to 80%; P = .02) and a decrease in the proportion meeting criteria for emotional exhaustion (53% to 40%; P = .05). Slightly more residents reported a negative effect of WHLs on patient care (37%) than they did a positive (29%) or a neutral (34%) effect, and more reported a negative effect on their education (47%) than they did a positive (32%) or a neutral (21%) effect. Overall, most residents (65%) approved of WHLs.
  
  
  CONCLUSIONS
  Internal medicine residents approve of WHLs overall and report benefits to their well-being. However, they also report negative effects on patient care and resident education.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Box 359762, University of Washington Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.
authors.forename: Lara
authors.initials: L
authors.lastname: Goitein
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Wipf
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
mesh_terms: D002055:Burnout, Professional / Q000523:psychology; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000523:psychology; D011787:Quality of Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014861:Washington; D014940:Work Schedule Tolerance