title: A qualitative assessment of internal medicine resident perceptions of graduate medical education following implementation of the 2011 ACGME duty hour standards.
abstract: BACKGROUND
  In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents.
  
  
  METHODS
  We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, "How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?" Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans.
  
  
  RESULTS
  Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study.
  
  
  CONCLUSIONS
  Residents noted a decline in teaching and are concerned with the decrease in "hands-on" clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education.
authors.affiliation: University of Alabama at Birmingham, 845 19th Street South, BBRB 220B, Birmingham, AL 35294, USA. crnevin@uab.edu.
authors.forename: Christa R
authors.initials: CR
authors.lastname: Nevin
authors.forename: Andrea
authors.initials: A
authors.lastname: Cherrington
authors.forename: Brita
authors.initials: B
authors.lastname: Roy
authors.forename: David D
authors.initials: DD
authors.lastname: Daly
authors.forename: J Martin
authors.initials: JM
authors.lastname: Rodriguez
authors.forename: Mukesh
authors.initials: M
authors.lastname: Patel
authors.forename: Erin D
authors.initials: ED
authors.lastname: Snyder
authors.forename: Angelo L
authors.initials: AL
authors.lastname: Gaffo
authors.forename: Joseph
authors.initials: J
authors.lastname: Barney
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
mesh_terms: D000068:Accreditation / Q000592:standards; D000407:Alabama; D001291:Attitude of Health Personnel; D004503:Education, Medical, Graduate / Q000458:organization & administration / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000592:standards; D036301:Qualitative Research; D014481:United States
references.citation: J Gen Intern Med. 2007 Jul;22(7):969-75
references.pmid: 17468888
references.citation: Am J Obstet Gynecol. 2006 Jun;194(6):1556-62
references.pmid: 16731071
references.citation: J Gen Intern Med. 2011 Aug;26(8):907-19
references.pmid: 21369772
references.citation: Laryngoscope. 2006 Jul;116(7):1127-30
references.pmid: 16826046
references.citation: Curr Surg. 2006 Nov-Dec;63(6):435-9; discussion 440
references.pmid: 17084773
references.citation: J Neurosurg. 2009 May;110(5):820-7
references.pmid: 19409028
references.citation: Pediatrics. 2012 Jul;130(1):99-107
references.pmid: 22665414
references.citation: J Am Coll Surg. 2012 Dec;215(6):868-77
references.pmid: 23040454
references.citation: Am Surg. 2008 Jun;74(6):542-6; discussion 546-7
references.pmid: 18556998
references.citation: Acad Med. 2006 Dec;81(12):1059-68
references.pmid: 17122470
references.citation: Arch Intern Med. 2005 Dec 12-26;165(22):2601-6
references.pmid: 16344417
references.citation: JAMA. 2005 Sep 7;294(9):1088-100
references.pmid: 16145030
references.citation: Neurosurgery. 2005 Feb;56(2):398-403; discussion 398-403
references.pmid: 15670388
references.citation: J Reprod Med. 2007 May;52(5):345-8
references.pmid: 17583230
references.citation: Clin Orthop Relat Res. 2006 Aug;449:128-33
references.pmid: 16735877
references.citation: Acad Med. 2006 Jan;81(1):63-7
references.pmid: 16377823
references.citation: Fam Med. 2007 Jun;39(6):392-8
references.pmid: 17549647
references.citation: J Bone Joint Surg Am. 2011 Dec 7;93(23):e1421-9
references.pmid: 22159864
references.citation: Ann Surg. 2012 Dec;256(6):1108-12
references.pmid: 23069864
references.citation: Am Surg. 2006 Jan;72(1):19-21
references.pmid: 16494176
references.citation: Can J Surg. 2011 Feb;54(1):25-32
references.pmid: 21251429