title: Quantitative and qualitative perceptions of the 2011 residency duty hour restrictions: a multicenter, multispecialty cross-sectional study.
abstract: BACKGROUND
  July 2011 saw the implementation of the newest duty hour restrictions, further limiting the working hours of first year residents and necessitating a variety of adaptations on the part of residency programs. The present study sought to characterize the perceived impact of these restrictions on residency program personnel using a multi-specialty and multi-site approach.
  
  
  METHODS
  We developed and administered a survey to internal medicine and general surgery residency programs at three academic medical centers within an urban region. The survey combined quantitative and qualitative components to gain a broader understanding of the impact of the newest regulations. Quantitative responses were compared between Internal Medicine and General Surgery programs with Student t-tests. Other comparisons were performed using ANOVA or Kruskal-Wallis testing as appropriate. For all comparisons, the threshold for significance was set at 0.01. Two independent reviewers coded all qualitative data and assigned one or more themes based on content. Descriptive statistics were calculated and the diversity of themes identified. No between-group comparisons were conducted with the qualitative data.
  
  
  RESULTS
  We found significant differences in the overall perceptions of duty hour restrictions across specialty (internal medicine more positive than general surgery) and across position (first year residents more positive than senior residents and faculty). Notably, individuals who trained at osteopathic medical schools reported significantly more negative views of the duty hour restrictions than those who had trained at allopathic or international medical schools, suggesting an influence of undergraduate medical training. The complementary qualitative data offered insights into the perceived strengths and weaknesses of the duty hour restrictions, as well as actionable suggestions that could help to improve residency program function.
  
  
  CONCLUSIONS
  This study characterizes responses to the new duty hour restrictions from a variety of perspectives. Our findings show that individual (type of undergraduate medical education, role in graduate medical education) and program-wide (e.g., specialty) factors contribute to participant satisfaction with DHR. This research highlights the value of a mixed methods approach in the study of duty hour restrictions, with our qualitative arm yielding rich data that complemented and expanded upon the insights derived from the quantitative data.
authors.affiliation: Cleveland Clinic Education Institute, 9500 Euclid Avenue, NA2-17, Cleveland, OH, 44195, USA. tiernew@ccf.org.
authors.forename: William S
authors.initials: WS
authors.lastname: Tierney
authors.affiliation: Cleveland Clinic Education Institute, 9500 Euclid Avenue, NA2-17, Cleveland, OH, 44195, USA. elkinr@ccf.org.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Elkin
authors.affiliation: Cleveland Clinic Education Institute, 9500 Euclid Avenue, NA2-17, Cleveland, OH, 44195, USA. nielsec@ccf.org.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Nielsen
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000328:Adult; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D010465:Perception; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload