Studying the effects of ACGME duty hours limits on resident satisfaction: results from VA learners' perceptions survey.
BACKGROUND
As the Accreditation Council on Graduate Medical Education (ACGME) deliberates over further limiting duty hours of graduate medical education (GME) trainees, few large-scale studies have shown residents to be satisfied with the effect the 2003 standards have had on clinical care, education outcomes, or working environments. This study measures the effect of the 2003 duty hours limits on resident-reported satisfaction with GME training during their rotations through the Department of Veterans Affairs (VA) medical centers from 2001 through 2007.


METHODS
Self-reported satisfaction with clinical care and education environments were assessed by comparing responses to VA's annual Learners' Perceptions Survey administered before 2003 with responses administered after 2003. To measure duty hours effects on satisfaction, before-after differences were adjusted for covariate biases modeled after an exhaustive covariate search with 10-fold cross-validation. Because nonteaching controls are not available in satisfaction studies, we used a robust differencing variable technique to control before-after differences for trend biases in the simultaneous presence of missing data and possible model misspecification.


RESULTS
There were 19,605 responders. Adjusting for covariate and trend biases, after the 2003 ACGME standards, 25% more residents in medicine specialties reported satisfaction with VA clinical environment and 11% more with VA preceptors and faculty. For surgery, 33% more residents reported satisfaction with VA clinical environment and 12% more with VA preceptors and faculty. Satisfaction with working environment was mixed.


CONCLUSIONS
The 2003 ACGME duty hours standards were associated with improved satisfaction for resident clinical training and learning environments.
Kashner
T Michael
TM
Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA. michael.kashner@va.gov <michael.kashner@va.gov>
Henley
Steven S
SS
Golden
Richard M
RM
Byrne
John M
JM
Keitz
Sheri A
SA
Cannon
Grant W
GW
Chang
Barbara K
BK
Holland
Gloria J
GJ
Aron
David C
DC
Muchmore
Elaine A
EA
Wicker
Annie
A
White
Halbert
H
D000068:Accreditation; D002983:Clinical Competence; D004219:District of Columbia; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D010549:Personal Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance / Q000523:psychology*; D016526:Workload / Q000523:psychology*