title: Differences in duty hours and their relationship with academic parameters between preliminary and categorical general surgery residents.
abstract: BACKGROUND
  There is the perceived notion that nondesignated preliminary general surgery (P-GS) interns are treated differently (i.e., overworked) than their categorical GS (C-GS) counterparts are treated, or in an effort to prove themselves worthy of a categorical position, nondesignated preliminary residents may self-choose to work more. Empirical evidence examining duty-hour differences between P-GS and C-GS residents is lacking.
  
  
  METHODS
  We retrospectively reviewed 4 academic years (July 2009 to June 2013) of our self-entered duty-hour database. Duty hours were averaged over 4-week periods and then averaged annually for each intern. Duty-hour averages and the percentage of conference attendance between P-GS and C-GS interns were compared. Sensitivity analyses were conducted to evaluate the effect of the 2011 duty-hour regulations, attendance to educational activities, seasonal variations in workload, and the Match Day effect.
  
  
  RESULTS
  A total of 70 P-GS and 43 C-GS interns were compared. Duty-hour averages (±standard deviation, range) were 64.4h/wk (±4.6; 45-70) for the P-GS interns and 64.1h/wk (±3.9; 57-72) for the C-GS interns, p = 0.8. Mean (±standard deviation, range) conference attendance was 61% (±17; 33-89) for the P-GS interns and 66% (±18; 44-85) for the C-GS interns (p = 0.13). Duty-hour averages for both the groups positively correlated with conference attendance (r = 0.27, p = <0.001). The P-GS and the C-GS interns worked on average 4.8 hours more a week after the implementation of the 2011 Accreditation Council of Graduate Medical Education duty-hour regulations when compared with before implementation (66.7 ± 4.1 vs 62 ± 3.1, p < 0.0001), with no difference between both the groups. No seasonal variation in duty hours was encountered for either group. For the P-GS interns, no difference in duty hours was observed before or after the Match Day.
  
  
  CONCLUSIONS
  At our institution, the P-GS and the C-GS interns have equivalent duty-hour periods and similar conference attendance. An expected, a positive correlation was observed between duty hours and conference attendance. Average weekly duty hours increased by almost 5 hours after the implementation of the 2011 duty-hour regulations.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eid
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Heller
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: farley.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D012189:Retrospective Studies; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data*
keywords: ACGME regulations; Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; duty hours; general surgery residency; preliminary residents; working hours