title: Perceived effects of the 16-hour workday restriction on surgical specialties: Quebec's experience.
abstract: OBJECTIVE
  Quebec was the first Canadian province to implement a 16-hour workday restriction. Our aim was to assess and compare Quebec's surgical residents' and professors' perception regarding the effects on the educational environment, quality of care, and quality of life.
  
  
  METHODS
  The Surgical Theater Educational Environment Measure, the Postgraduate Hospital Educational Environment Measure, quality of the medical act, and quality-of-life questionnaires were administered 6 months after the work-hour restrictions.
  
  
  METHODS
  Université de Montréal Surgery Department, Montréal, Québec, Canada; Université de Sherbrooke Surgery Department, Sherbrooke, Québec, Canada; Université Laval Surgery Department, Québec, Québec, Canada; and McGill University Surgery Department, Montréal, Québec, Canada.
  
  
  METHODS
  Surgical residents and professors of all specialties within the 4 university surgery departments in Quebec through a voluntary web-based survey.
  
  
  RESULTS
  A total of 280 questionnaires were analyzed with response rates of 29.7% and 16.4% for residents and professors, respectively. Data were coded on a scale from 2 (strong improvement perception) to -2 (strong deterioration perception). The professors perceived a higher negative effect than the residents did on the educational environment, i.e., role of autonomy (-0.399 vs. -0.577, p < 0.001), teaching (-0.496 vs. -0.540, p < 0.001), social support (-0.345 vs. -0.535, p < 0.001), and surgical learning (-0.409 vs. -0.626, p < 0.001). The professors also observed a higher negative effect on patients' safety (-0.199 vs. -0.595, p = 0.003) and quality of care (-0.077 vs. -0.421, p = 0.014). The latter was even perceived as unchanged by residents (-0.077, 95% CI: -0.249 to 0.095). The residents perceived a negative effect on their quality of life, whereas the professors believed the contrary (0.500 vs -0.496, p < 0.001). More professors than residents believed residency should be prolonged (80.8% vs. 50.6%, p < 0.001).
  
  
  CONCLUSIONS
  Residents and professors perceive a mild negative effect on the educational environment and quality of care, whereas their perception on quality of life is opposite. The professors seem concerned about adequate training to the point of considering increasing training length.
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada. Electronic address: seby.lachance@gmail.com.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Lachance
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Latulippe
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Valiquette
authors.affiliation: Département de chirurgie, Université de Sherbrooke, Quebec, Canada.
authors.forename: Gaétan
authors.initials: G
authors.lastname: Langlois
authors.affiliation: Département de chirurgie, Université Laval, Quebec, Canada.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Douville
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada; Département de chirurgie, Université de Montréal, Quebec, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Richard
mesh_terms: D001291:Attitude of Health Personnel; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011787:Quality of Health Care; D011788:Quality of Life; D011792:Quebec; D013043:Specialties, Surgical / Q000193:education* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data*
keywords: Medical Knowledge; Patient Care; Professionalism; residents’ quality of life; work-hour restriction