title: Orthopedic Residency: Are Duty Hours Predictive of Performance?
abstract: OBJECTIVE
  This study examines the relationship between self-recorded resident work hours and Orthopedic In-training Examination (OITE) scores, resident clinical performance, and American Board of Orthopedic Surgery pass rates. The hypothesis of this study is that increasing duty hours would have a positive correlation with clinical and OITE performance.
  
  
  METHODS
  Total duty hours and recorded operating room hours from a single orthopedic residency program were extracted from 2006 to 2012. During the same time span, OITE scores, resident clinical scores from the E-Valuation system, and American Board of Orthopedic Surgery pass rates were collected. The correlation between the variables was assessed using the Pearson correlation coefficient's precision statistic.
  
  
  METHODS
  A large public tertiary academic center in the upper Midwestern United States.
  
  
  METHODS
  A total of 82 orthopedic surgery residents over 7 years.
  
  
  RESULTS
  A total of 82 residents were matriculated between 2006 and 2012. The average weekly recorded duty hours were as follows: postgraduate year 2 (PGY2) = 60 hours/week (Standard Deviation (SD) ± 4), PGY3 = 59 hours/week (SD ± 5), PGY4 = 51 hours/week (SD ± 4), PGY5 = 49 hours/week (SD ± 3). There was significant variability in the average number of hours worked among residents (range: 2128-3753h/y) for the full academic year. The OITE scores and the work hours were found to be independent of each other (ρ = 0.017, p = 0.825), and no correlation was found between OITE scores and the resident E-value scores (ρ = 0.071, p = 0.34). Residents spent 36% to 48% of their time in the operating room. Second year residents logging more hours scored higher on faculty evaluation of overall competency (ρ = 0.31, p = 0.035). Faculty assessment of technical skills had a positive correlation with operating room duty hours for PGY5 class (ρ = 0.346, p = 0.025).
  
  
  CONCLUSIONS
  A large variation in duty hours exists between resident-logged duty hours. No correlation exists between in-training scores and duty hours. There is a positive correlation between senior resident operating room hours and technical skill scores.
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minneapolis, Minnesota.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Bohm
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Hill
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minneapolis, Minnesota.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Braman
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minneapolis, Minnesota.
authors.forename: Thuan V
authors.initials: TV
authors.lastname: Ly
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri. Electronic address: vanhe003@umn.edu.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Van Heest
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008910:Minnesota; D009985:Orthopedics / Q000193:education*; D016526:Workload
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; duty hours; orthopedic surgery; resident education; resident performance