title: Of duty hour violations and shift work: changing the educational paradigm.
abstract: BACKGROUND
  Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education.
  
  
  METHODS
  A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system.
  
  
  RESULTS
  Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%.
  
  
  CONCLUSIONS
  Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time.
authors.affiliation: UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Kohlbrenner
authors.affiliation: UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dirks
authors.affiliation: UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.affiliation: UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Wolfe
authors.affiliation: UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 155 North Fresno Street, Fresno, CA, 93701, USA. Electronic address: cmaser@fresno.ucsf.edu.
authors.forename: Christina
authors.initials: C
authors.lastname: Maser
mesh_terms: D039602:After-Hours Care / Q000331:legislation & jurisprudence*; D002055:Burnout, Professional / Q000517:prevention & control*; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000639:trends; D011786:Quality Control; D011795:Surveys and Questionnaires; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data
keywords: Duty hour restrictions; Shift work; Surgical education