title: Effect of the 16-hour work limit on general surgery intern operative case volume: a multi-institutional study.
abstract: OBJECTIVE
  The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction.
  
  
  OBJECTIVE
  To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience.
  
  
  METHODS
  A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included.
  
  
  METHODS
  Total, major, first-assistant, and defined-category case totals.
  
  
  RESULTS
  As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases.
  
  
  CONCLUSIONS
  The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.
authors.affiliation: Department of Surgery, Harbor-University of California at Los Angeles Medical Center, Torrance2Department of Emergency Medicine, Harbor-University of California at Los Angeles Medical Center, Torrance.
authors.forename: Samuel I
authors.initials: SI
authors.lastname: Schwartz
authors.forename: Joseph
authors.initials: J
authors.lastname: Galante
authors.forename: Amy
authors.initials: A
authors.lastname: Kaji
authors.forename: Matthew
authors.initials: M
authors.lastname: Dolich
authors.forename: David
authors.initials: D
authors.lastname: Easter
authors.forename: Marc L
authors.initials: ML
authors.lastname: Melcher
authors.forename: Kevin
authors.initials: K
authors.lastname: Patel
authors.forename: Mark E
authors.initials: ME
authors.lastname: Reeves
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Danny M
authors.initials: DM
authors.lastname: Takanishi
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
mesh_terms: D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D012189:Retrospective Studies; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*