title: Achieving Accreditation Council for Graduate Medical Education duty hours compliance within advanced surgical training: a simulation-based feasibility assessment.
abstract: BACKGROUND
  Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience.
  
  
  METHODS
  A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule.
  
  
  RESULTS
  For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume.
  
  
  CONCLUSIONS
  The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: easta@med.umich.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Obi
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Wandi
authors.initials: W
authors.lastname: Lin
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Siyuan
authors.initials: S
authors.lastname: Sun
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: William
authors.initials: W
authors.lastname: Pozehl
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Industrial and Operations Engineering, Center for Healthcare Engineering and Patient Safety, Ann Arbor, MI, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Cohn
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Daskin
authors.affiliation: Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: F Jacob
authors.initials: FJ
authors.lastname: Seagull
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Rishindra M
authors.initials: RM
authors.lastname: Reddy
mesh_terms: D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000592:standards*; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education; D016027:Heart Transplantation / Q000193:education* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D016040:Lung Transplantation / Q000193:education* / Q000706:statistics & numerical data; D061646:Operative Time; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States
keywords: Computer simulation; Heart transplantation; Lung transplantation; Medical education; Regulation