title: Factors associated with intern noncompliance with the 2003 Accreditation Council for Graduate Medical Education's 30-hour duty period requirement.
abstract: BACKGROUND
  In 2003 the Accreditation Council for Graduate Medical Education mandated work hour restrictions. Violations can results in a residency program being cited or placed on probation. Recurrent violations could results in loss of accreditation. We wanted to determine specific intern and workload factors associated with violation of a specific mandate, the 30-hour duty period requirement.
  
  
  METHODS
  Retrospective review of interns' performance against the 30-hour duty period requirement during inpatient ward rotations at a pediatric residency program between June 24, 2008 and June 23, 2009. The analytical plan included both univariate and multivariable logistic regression analyses.
  
  
  RESULTS
  Twenty of the 26 (77%) interns had 80 self-reported episodes of continuous work hours greater than 30 hours. In multivariable analysis, noncompliance was inversely associated with the number of prior inpatient rotations (odds ratio: 0.49, 95% confidence interval (0.38, 0.64) per rotation) but directly associated with the total number of patients (odds ratio: 1.30 (1.10, 1.53) per additional patient). The number of admissions on-call, number of admissions after midnight and number of discharges post-call were not significantly associated with noncompliance. The level of noncompliance also varied significantly between interns after accounting for intern experience and workload factors. Subject to limitations in statistical power, we were unable to identify specific intern characteristics, such as demographic variables or examination scores, which account for the variation in noncompliance between interns.
  
  
  CONCLUSIONS
  Both intern and workload factors were associated with pediatric intern noncompliance with the 30-hour duty period requirement during inpatient ward rotations. Residency programs must develop information systems to understand the individual and experience factors associated with noncompliance and implement appropriate interventions to ensure compliance with the duty hour regulations.
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. chris.maloney@hsc.utah.edu
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
authors.forename: Armand H Matheny
authors.initials: AH
authors.lastname: Antommaria
authors.forename: James F
authors.initials: JF
authors.lastname: Bale
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D000068:Accreditation / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D000328:Adult; D016001:Confidence Intervals; D004503:Education, Medical, Graduate / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics / Q000193:education / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D057566:Self Report; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States; D014589:Utah; D016526:Workload