title: Assessing the effects of the 2003 resident duty hours reform on internal medicine board scores.
abstract: OBJECTIVE
  To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents.
  
  
  METHODS
  The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform.
  
  
  RESULTS
  The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were -5.43 (-7.63, -3.23), -3.44 (-5.65, -1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores.
  
  
  CONCLUSIONS
  The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations.
authors.affiliation: Dr. Silber is professor, Departments of Pediatrics and Anesthesiology & Critical Care, Perelman School of Medicine; professor, Department of Health Care Management, The Wharton School; director, Center for Outcomes Research, The Children's Hospital of Philadelphia; and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Romano is professor of medicine and pediatrics and director, Primary Care Outcomes Research Faculty Development Program, Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California. Dr. Itani is professor, Department of Surgery, Boston University School of Medicine, and chief of surgery, VA Boston Health Care System and Boston University, Boston, Massachusetts. Dr. Rosen is professor, Department of Health Policy and Management, Boston University School of Public Health, affiliated with the Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, Massachusetts. Dr. Small is associate professor, Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Lipner is senior vice president of evaluation, research and development, American Board of Internal Medicine, Philadelphia, Pennsylvania. Dr. Bosk is professor, Departments of Sociology and Medical Ethics & Health Policy, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Wang is a statistical programmer, Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Mr. Halenar is a research assistant, Center for Health Equity Research and Promotion, Veteran's Administration Hospital, Philadelphia, Pennsylvania. Ms. Korovaichuk is a research assistant, Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Ms. 
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Dylan
authors.initials: D
authors.lastname: Small
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bosk
authors.forename: Yanli
authors.initials: Y
authors.lastname: Wang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Halenar
authors.forename: Sophia
authors.initials: S
authors.lastname: Korovaichuk
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013044:Specialty Boards; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data*