title: Effects of the reduction of surgical residents' work hours and implications for surgical residency programs: a narrative review.
abstract: BACKGROUND
  The widespread implementation of resident work hour restrictions has led to significant alterations in surgical training and the postgraduate educational experience. We evaluated the experience of surgical residency programs as reflected in the literature from 2008 onward in order to summarize current challenges and identify key areas in need of further research.
  
  
  METHODS
  We searched MEDLINE and EMBASE for English-language articles published from January 2008 to December 2011 related to work hour restrictions in surgical residency programs, including those pertaining to personal well-being, education and training, patient care, and faculty experiences.
  
  
  RESULTS
  We retrieved 240 unique abstracts and included 24 studies in the current review. Of the 10 studies examining effects on operating room experience, 4 reported negative or mixed outcomes and 6 reported neutral outcomes, although non-compliance was demonstrated in 2 of these studies. Effects on surgical faculty perceptions were consistently reported as negative, while the effect on patient outcomes and professionalism were found to be neutral and unchanged.
  
  
  CONCLUSIONS
  Further studies are needed to characterize operative experience at varying levels of training, particularly in the context of strict adherence to new work hours. Research that examines the effect of the work hour limitations on professionalism and non-operative educational activities, such as reading and simulation-based training, as well as sign-over practices, would also be of benefit.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Jamal
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wong
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Whalen
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D016206:Databases, Bibliographic; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D019983:Guideline Adherence; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards / Q000639:trends; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D011788:Quality of Life; D012892:Sleep Deprivation / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D014481:United States; D014940:Work Schedule Tolerance