title: Internal medicine residents' clinical and didactic experiences after work hour regulation: a survey of chief residents.
abstract: BACKGROUND
  Work hour regulations for house staff were intended in part to improve resident clinical and educational performance.
  
  
  OBJECTIVE
  To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education.
  
  
  METHODS
  Cross-sectional mail survey.
  
  
  METHODS
  Chief residents at all accredited U.S. internal medicine residency programs outside New York.
  
  
  RESULTS
  The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities.
  
  
  CONCLUSIONS
  In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA. leora.horwitz@yale.edu
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Huot
authors.forename: Michael L
authors.initials: ML
authors.lastname: Green
mesh_terms: D016009:Chi-Square Distribution; D004503:Education, Medical, Graduate / Q000331:legislation & jurisprudence* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence* / Q000458:organization & administration / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence* / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States; D016526:Workload / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data