title: Multifaceted longitudinal study of surgical resident education, quality of life, and patient care before and after July 2011.
abstract: OBJECTIVE
  Resident duty-hour regulatory changes in July 2011 led to dramatic modifications in the structure of many surgical training programs in the United States. These changes were hypothesized to have effects on the quality of life and education of residents, and the patient care they deliver. Our study aims to measure changes in these domains among junior and senior residents before and after implementation of the latest regulations.
  
  
  METHODS
  Longitudinal cohort study comparing objective and subjective metrics of education, patient care, and quality of life among all surgical residents at one institution.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  All residents in the Department of Surgery over 2 years (n = 97) were included. The included electronic survey had 30 and 36 responses in 2011 and 2012, respectively (overall 68% response rate).
  
  
  RESULTS
  Operative cases increased for residents at all postgraduate year levels. No significant differences in in-training examination scores were observed. Comparison of subjective data from the program evaluation and developed survey revealed a significant decrease in perception of resident clinical skill development (4.31/5 in 2011 to 4.15/5 in 2012, p = 0.02). Residents reported decreased quality of operative experiences (83% to 59%, p = 0.04), and less independence evaluating patient problems (90% to 61%, p < 0.01). Levels of burnout were high in the entire group, but decreased significantly over the study period (93% and 75% in 2011 and 2012, respectively, p = 0.05), with the largest difference seen in individuals with "high burnout" (43% and 11%, in 2011 and 2012, respectively, p < 0.01). Residents met criteria for "sleepiness" before and after the 16-hour rule implementation (68% and 67%, in 2011 and 2012, respectively, p = 0.92).
  
  
  CONCLUSIONS
  Following the July 2011 duty-hour changes, surgical residents report a negative effect on their education, with decreased clinical skill progression and perceptions of operative experience quality and patient care independence. Improvements in quality of life metrics, including burnout, were observed.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: b.lindeman@jhmi.edu.
authors.forename: Brenessa M
authors.initials: BM
authors.lastname: Lindeman
authors.forename: Bethany C
authors.initials: BC
authors.lastname: Sacks
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008137:Longitudinal Studies; D008297:Male; D005791:Patient Care / Q000379:methods; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence*; D058996:Quality Improvement; D011788:Quality of Life; D062606:Tertiary Care Centers; D013997:Time Factors; D014481:United States; D014940:Work Schedule Tolerance / Q000523:psychology*; D016526:Workload
keywords: Medical Knowledge; Patient Care; Professionalism; duty hours; graduate medical education; quality of life; residents