title: Resident perceptions of the impact of work hour limitations.
abstract: BACKGROUND
  Mandatory work hour limitations for residents began in July 2003. There has been little evaluation of the impact of the new limitations on Internal Medicine residency training.
  
  
  OBJECTIVE
  To assess Internal Medicine residents' perceptions of the impact of work hour limitations on clinical experiences, patient care, resident education, and well-being, and their compliance with the limitations.
  
  
  METHODS
  Cross-sectional survey administered to Internal Medicine residents at 1 large U.S. teaching hospital.
  
  
  METHODS
  Resident perceptions using 5-point Likert scales, and self-reported compliance. Exploratory factor analysis was used to identify underlying domains and develop scales.
  
  
  RESULTS
  The survey response rate was 85%. Five domains were identified by factor analysis: 1) clinical experience, 2) patient care and safety, 3) communication, 4) satisfaction with training, and 5) work-rest balance. Residents perceived work hour limitations to have a negative impact on clinical experience (mean scale score 1.84, 1 = negative, 5 = positive), patient care and safety (2.64), and communication domains (1.98). Effects on satisfaction (3.12) and work-rest balance domains (2.95) were more positive. Senior residents perceived more negative effects of work hour limitations than interns. Compliance was difficult; 94% interns and 70% residents reported violating work hour limits. Patient care and teaching duties were the main reasons for work hour violations.
  
  
  CONCLUSIONS
  This study suggests that the current work hour limitations may be having unintended negative consequences on residency training. Ongoing monitoring to evaluate the impact of program changes as a result of work hour regulation is crucial to improving residency training.
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, Box 1364, SFGH, San Francisco, CA 94143, USA. glin@medsfgh.ucsf.edu
authors.forename: Grace A
authors.initials: GA
authors.lastname: Lin
authors.forename: David C
authors.initials: DC
authors.lastname: Beck
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
authors.forename: Jane M
authors.initials: JM
authors.lastname: Garbutt
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D005163:Factor Analysis, Statistical; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007588:Job Satisfaction; D008297:Male; D016272:Occupational Health; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D013663:Teaching; D014940:Work Schedule Tolerance; D016526:Workload / Q000523:psychology*