title: On resident duty hour restrictions and neurosurgical training: review of the literature.
abstract: Within neurosurgery, the national mandate of the 2003 duty hour restrictions (DHR) by the Accreditation Council for Graduate Medical Education (ACGME) has been controversial. Ensuring the proper education and psychological well-being of residents while fulfilling the primary purpose of patient care has generated much debate. Most medical disciplines have developed strategies that address service needs while meeting educational goals. Additionally, there are numerous studies from those disciplines; however, they are not specifically relevant to the needs of a neurosurgical residency. The recent implementation of the 2011 DHR specifically aimed at limiting interns to 16-hour duty shifts has proven controversial and challenging across the nation for neurosurgical residencies--again bringing education and service needs into conflict. In this report the current literature on DHR is reviewed, with special attention paid to neurosurgical residencies, discussing resident fatigue, technical training, and patient safety. Where appropriate, other specialty studies have been included. The authors believe that a one-size-fits-all approach to residency training mandated by the ACGME is not appropriate for the training of neurosurgical residents. In the authors' opinion, an arbitrary timeline designed to limit resident fatigue limits patient care and technical training, and has not improved patient safety.
authors.affiliation: Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Bina
authors.affiliation: Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Lemole
authors.affiliation: Department of Surgery, Division of Neurosurgery, The University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
mesh_terms: D002983:Clinical Competence; D005221:Fatigue; D006801:Humans; D007396:Internship and Residency; D009493:Neurosurgery / Q000193:education*; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D014481:United States; D016526:Workload
keywords: ACGME = Accreditation Council for Graduate Medical Education; Accreditation Council for Graduate Medical Education; DHR = duty hour restrictions; OR = operating room; duty hours; neurosurgery residency; resident education