title: Strategies to accommodate resident work-hour restrictions: impact on surgical education.
abstract: BACKGROUND
  The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education.
  
  
  METHODS
  A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful).
  
  
  RESULTS
  A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education.
  
  
  CONCLUSIONS
  Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value.
authors.affiliation: University of Vermont, Burlington, VT 05401, USA.
authors.forename: Carter
authors.initials: C
authors.lastname: Freiburg
authors.forename: Ted
authors.initials: T
authors.lastname: James
authors.forename: Takamura
authors.initials: T
authors.lastname: Ashikaga
authors.forename: Jacob
authors.initials: J
authors.lastname: Moalem
authors.forename: Greg
authors.initials: G
authors.lastname: Cherr
mesh_terms: D003625:Data Collection; D004521:Educational Measurement; D004526:Efficiency; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D009656:North America; D010561:Personnel Staffing and Scheduling; D012577:Schools, Medical / Q000706:statistics & numerical data; D014940:Work Schedule Tolerance; D016526:Workload