title: The effect of reducing maximum shift lengths to 16 hours on internal medicine interns' educational opportunities.
abstract: OBJECTIVE
  To evaluate educational experiences of internal medicine interns before and after maximum shift lengths were decreased from 30 hours to 16 hours.
  
  
  METHODS
  The authors compared educational experiences of internal medicine interns at Vanderbilt University Medical Center before (2010; 47 interns) and after (2011; 50 interns) duty hours restrictions were implemented in July 2011. The authors compared number of inpatient encounters, breadth of concepts in notes, exposure to five common presenting problems, procedural experience, and attendance at teaching conferences.
  
  
  RESULTS
  Following the duty hours restrictions, interns cared for more unique patients (mean 118 versus 140 patients per intern, P = .005) and wrote more history and physicals (mean 73 versus 88, P = .005). Documentation included more total concepts after the 16-hour maximum shift implementation, with a 14% increase for history and physicals (338 versus 387, P < .001) and a 10% increase for progress notes (316 versus 349, P < .001). There was no difference in the median number of selected procedures performed (6 versus 6, P = 0.94). Attendance was higher at the weekly chief resident conference (60% versus 68% of expected attendees, P < .001) but unchanged at morning report conferences (79% versus 78%, P = .49).
  
  
  CONCLUSIONS
  Intern clinical exposure did not decrease after implementation of the 16-hour shift length restriction. In fact, interns saw more patients, produced more detailed notes, and attended more conferences following duty hours restrictions.
authors: Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee 37212, USA. cecelia.theobald@vanderbilt.edu
authors: Cecelia N
authors: CN
authors: Theobald
authors: Daniel G
authors: DG
authors: Stover
authors: Neesha N
authors: NN
authors: Choma
authors: Jacob
authors: J
authors: Hathaway
authors: Jennifer K
authors: JK
authors: Green
authors: Neeraja B
authors: NB
authors: Peterson
authors: Kelly C
authors: KC
authors: Sponsler
authors: Eduard E
authors: EE
authors: Vasilevskis
authors: Sunil
authors: S
authors: Kripalani
authors: John
authors: J
authors: Sergent
authors: Nancy J
authors: NJ
authors: Brown
authors: Joshua C
authors: JC
authors: Denny
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D013714:Tennessee; D013997:Time Factors; D014940:Work Schedule Tolerance; D016526:Workload