title: Operative Variability Among Residents Has Increased Since Implementation of the 80-Hour Workweek.
abstract: The ACGME instituted duty hour restrictions in 2003. This presents a challenge for surgical residents who must acquire a medical and technical knowledge base during their training. Although the effect of work hour limitations on operative volume has been examined, no study has examined whether duty hour reform has had an effect on operative volume variability.
  
  
  
  The ACGME operative log data of graduating general surgery residents from 1992 to 2015 were examined. Residents with the most and fewest total major cases were identified and case logs, learning styles, and evaluations were analyzed. Statistical analysis was performed using linear regression analysis, chi-square test, Student's t-test, and Wilcoxon rank sum test. Significance was defined as p < 0.05.
  
  
  
  One hundred and thirty-five residents graduated from 1992 to 2015. No change in overall operative volume was seen after the 2003 duty hour reform, however, there was an increase in operative variability. In addition, there was an increase in the variability of total major cases between the resident completing the most and fewest cases per class (183.3; p = 0.02) after the start of work hour restrictions. The residents who graduated with the highest operative volume were more likely to be action-based learners (odds ratio = 6.81; 95% CI, 2.84-16.34; p < 0.001) and received superior evaluation scores.
  
  
  
  After the implementation of the 80-hour workweek, we found a significant increase in operative variability. This might suggest a growing disparity in the operative experience among surgical residents and, consequently, a varying quality of graduating residents. Programs should therefore consider using learning styles and developing competency-based training curricula to ensure equitable training among all trainees.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH. Electronic address: quillirc@email.uc.edu.
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Quillin
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Cortez
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Pritts
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Davis
mesh_terms: D005260:Female; D013502:General Surgery / Q000193:education* / Q000458:organization & administration / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D016014:Linear Models; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000193:education / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States; D016526:Workload / Q000592:standards*