title: A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms.
abstract: OBJECTIVE
  To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being.
  
  
  METHODS
  The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies.
  
  
  RESULTS
  A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs.
  
  
  CONCLUSIONS
  The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.
authors.affiliation: H. Lin is a pediatric gastroenterologist, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. E. Lin is a gastroenterology fellow, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. S. Auditore is market segment development manager, American Medical Association, Chicago, Illinois. J. Fanning is chief of membership and resident fellow member-early career psychiatrist officer, American Psychiatric Association, Arlington, Virginia.
authors.forename: Henry
authors.initials: H
authors.lastname: Lin
authors.forename: Emery
authors.initials: E
authors.lastname: Lin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Auditore
authors.forename: Jon
authors.initials: J
authors.lastname: Fanning
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D014481:United States; D014940:Work Schedule Tolerance