title: Patient Perceptions of Whom is Most Involved in Their Care with Successive Duty Hour Limits.
abstract: BACKGROUND
  Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours.
  
  
  OBJECTIVE
  We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours.
  
  
  METHODS
  This was a prospective observational study over 12 years at a single institution.
  
  
  METHODS
  Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview.
  
  
  METHODS
  Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011).
  
  
  RESULTS
  With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p < 0.001). Simultaneously, fewer patients reported a housestaff physician (resident or intern) as most involved in their care (pre-2003 20 %, post-2003-pre-2011 17 %, post-2011 12 %, p < 0.001). In multinomial regression models controlling for patient age, race, gender and hospitalist as teaching attending, the relative risk ratio of naming the resident versus the attending was higher in the pre-2003 period (1.44, 95 % CI 1.28-1.62, p < 0.001) than the post-2003-pre-2011 (reference group). In contrast, the relative risk ratio for naming the resident versus the attending was lower in the post-2011 period (0.79, 95 % CI 0.68-0.93, p = 0.004) compared to the reference group.
  
  
  CONCLUSIONS
  After successive residency duty hours limits, hospitalized patients were more likely to report the attending physician and less likely to report the resident or intern as most involved in their hospital care. Given the importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.
authors.affiliation: Section of General Medicine, University of Chicago, Chicago, IL, USA, varora@medicine.bsd.uchicago.edu.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.forename: Micah T
authors.initials: MT
authors.lastname: Prochaska
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Farnan
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D000368:Aged; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling; D010819:Physician's Role; D010817:Physician-Patient Relations; D011446:Prospective Studies; D016526:Workload