title: No Correlation Between Work-Hours and Operative Volumes--A Comparison Between United States and Danish Operative Volumes Achieved During Surgical Residency.
abstract: OBJECTIVE
  Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week. We hypothesize that there is no direct correlation between work-hours and operative volume achieved during surgical residency. To test the hypothesis, we compare Danish and US operative volumes achieved during surgical residency training.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  The data from the US population was extracted from the Accreditation Council for Graduate Medical Education database for General Surgery residents from 2012 to 2013. For Danish residents, a questionnaire with case categories matching the Accreditation Council for Graduate Medical Education categories were sent to all Danish surgeons graduating the national surgical residency program in 2012 or 2013, 54 in total.
  
  
  RESULTS
  In all, 30 graduated residents (55%) responded to the Danish survey. We found no significant differences in mean total major procedures (1002.4 vs 976.9, p = 0.28) performed during residency training, but comparing average major procedures per year, the US residents achieve significantly more (132.3 vs 195.4, p <0.01). When factoring in differences in time spent in training, this amounts to a weekly average difference of 1.2 cases throughout training.
  
  
  CONCLUSIONS
  In this study, we find no difference in overall surgical volumes between Danes and US residents during their surgical training. When time in training was accounted for, differences between weekly surgical volumes achieved were minor, indicating a lack of direct correlation between weekly work-hours and operative volumes achievable. Factors other than work-hours seem to effect on operative volumes achieved during training.
authors.affiliation: Department of Surgery, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Kjærgaard
authors.affiliation: Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Sillesen
authors.affiliation: Department of Surgery, Copenhagen University Hospital, Hillerød, Denmark. Electronic address: Randi.beier-holgersen@regionh.dk.
authors.forename: Randi
authors.initials: R
authors.lastname: Beier-Holgersen
mesh_terms: D003718:Denmark; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data*
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; surgery; training; volume; work-hours