Investigating the Impact of the 2011 ACGME Resident Duty Hour Regulations on Surgical Residency Programs: The Program Director Perspective.
BACKGROUND
The 2011 ACGME regulations required substantial changes to the structure of general surgery residency programs, due primarily to the 16-hour in-house rule for PGY1 residents. However, the scope of changes that programs have undertaken to meet these requirements, and the educational impact of those changes, are poorly understood.


METHODS
We performed in-depth qualitative interviews with general surgery program directors. Twenty program directors participated in the study; interviews were conducted until adequate thematic saturation was achieved. Participants were recruited from a stratified random sampling of residency programs in the United States to ensure a representative cohort. Interviews focused on changes in call schedule, interns' educational requirements, development, and satisfaction.


RESULTS
Most programs used a month-long night float (NF) rotation (14 of 20 [75%]). A minority of programs (5 of 20 [25%]) used a weekly rotating schedule, in which interns worked 5 to 6 nights in a month. Multiple programs (65%) had an NF in place before 2011; these programs made changes to and expanded their existing schedule to accommodate the new regulations. Commonly cited challenges to instituting NF included weekend coverage (60%) and providing adequate days off during day-to-night transition. Interns spent as much as 3 months of the year on NF. Only 5 programs made explicit changes to teaching schedules or developed a curriculum for residents on NF. Seventy-five percent of programs excused interns, explicitly or implicitly, from didactic teaching when on NF. Common themes noted by program directors included delayed maturation of trainees, interns being isolated from the team culture, and a conflict between the professional behaviors of "following the rules" and "doing what is right."
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: cscally@med.umich.edu.
Christopher P
CP
Scally
Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
Gurjit
G
Sandhu
Department of Surgery, University of Michigan, Ann Arbor, MI.
Christopher
C
Magas
Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
Paul G
PG
Gauger
Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
Rebecca M
RM
Minter
D004502:Education, Medical, Continuing; D013502:General Surgery / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods*; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*