Differences in Resident Perceptions by Postgraduate Year of Duty Hour Policies: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.
BACKGROUND
In the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, there were several differences in residents' perceptions of aspects of their education, well-being, and patient care that differed between standard and flexible duty hour policies. Our objective was to assess whether these perceptions differed by level of training.


METHODS
A survey assessed residents participating in the FIRST trial's perceptions of the effect of duty hour policies on aspects of patient safety, continuity of care, resident education, clinical training, and resident well-being. Hierarchical logistic regression models were used to examine the association between residents' perceptions, study arm, and level of training (interns, junior residents, and senior residents).


RESULTS
In the Standard Policy arm, as the PGY level increased, residents more frequently reported that duty hour policies negatively affected patient safety, professionalism, morale, and career choice (all interactions p < 0.001). However, in the Flexible Policy arm, as the PGY level increased, residents less frequently perceived negative effects of duty hour policies on resident health, rest, and time for family and friends and extracurricular activities (all interactions p < 0.001). Overall, there was an increase by PGY level in the proportion of residents expressing a preference for training in programs with flexible duty hour policies, and this preference for flexible duty hour policies was even more apparent among residents who were in the Flexible Policy arm (p < 0.001).


CONCLUSIONS
As PGY level increased, residents had increasing concerns about patient care and resident education and training under standard duty hour policies, but they had decreasing concerns about well-being under flexible policies. When given the choice between training under standard or flexible duty hour policies, only 14% of residents expressed a preference for standard policies.
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
Anthony D
AD
Yang
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
Jeanette W
JW
Chung
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
Allison R
AR
Dahlke
American Board of Surgery, Philadelphia, PA.
Thomas
T
Biester
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
Christopher M
CM
Quinn
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
Richard S
RS
Matulewicz
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL.
David D
DD
Odell
Department of Surgery and Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Rachel R
RR
Kelz
Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Judy A
JA
Shea
American Board of Surgery, Philadelphia, PA.
Frank
F
Lewis
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, IL; American College of Surgeons, Chicago, IL. Electronic address: k-bilimoria@northwestern.edu.
Karl Y
KY
Bilimoria
D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D013502:General Surgery / Q000193:education* / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D007588:Job Satisfaction; D016015:Logistic Models; D008297:Male; D061214:Patient Safety / Q000592:standards; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload / Q000592:standards*