title: Association Between Resident Perceptions of Patient Safety and Duty Hour Violations.
abstract: BACKGROUND
  Residents are often required to balance whether to adhere to duty hour policies or violate them to care for patients and obtain educational experiences. Little is known about why residents violate duty hour policies and whether there is a relationship between how often residents violate duty hours and concerns about patient safety. Our objective was to assess the association between resident duty hour violations and resident concerns about patient safety.
  
  
  METHODS
  We analyzed survey data collected from surgery residents who completed the 2015 American Board of Surgery In-Training Examination, excluding those in the Flexible Policy arm of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial. Perceptions of how duty hour restrictions affect patient safety were dichotomized as either "positive/neutral" or "negative." Resident duty hour violations in a typical month were separated as "frequently" (≥3 times) or "infrequently" (<3 times). Rates were compared and regression models were used to examine the association between negative perceptions and duty hour violations, adjusting for resident and program-level covariates.
  
  
  RESULTS
  Overall, 25.3% of trainees under current policies perceived that current ACGME duty hour policies negatively affected patient safety. This negative perception increased with PGY level (PGY1: 18.5%, PGY2 to 3: 22.6%, PGY4 to 5: 32.0%; p < 0.001). Residents with negative perceptions more often reported frequent duty violations (positive/neutral: 20.0% vs negative: 32.7%; p < 0.001). After adjustment for covariates, a negative perception of how duty hour policies affect patient safety was significantly associated with a higher likelihood of frequent duty hour violations among all trainees grouped together (odds ratio [OR] = 1.89; 95% CI, 1.60-2.22), and separately for interns (OR = 2.59; 95% CI, 1.70-3.93), junior (OR = 1.62; 95% CI 1.22-2.16), and senior residents (OR = 1.99; 95% CI, 1.54-2.58).
  
  
  CONCLUSIONS
  Trainees who reported perceiving negative effects of duty hour policies on patient safety were more likely to report frequent duty hour violations.
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Matulewicz
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jeanette W
authors.initials: JW
authors.lastname: Chung
authors.affiliation: American College of Surgeons, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Ban
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Yang
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; American College of Surgeons, Chicago, IL. Electronic address: k-bilimoria@northwestern.edu.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery / Q000193:education* / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload / Q000592:standards* / Q000706:statistics & numerical data