title: Association Between Flexible Duty Hour Policies and General Surgery Resident Examination Performance: A Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Analysis.
abstract: BACKGROUND
  Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared with current ACGME duty hour policy (Standard Policy).
  
  
  METHODS
  We obtained examination scores on the American Board of Surgery In-Training Examination, Qualifying Examination (written boards), and Certifying Examination (oral boards) for residents in 117 general surgery residency programs that participated in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. Using bivariate analyses and regression models, we compared resident examination performance across study arms (Flexible Policy vs Standard Policy) for 2015 and 2016, and 1 year of the Qualifying Examination and Certifying Examination. Adjusted analyses accounted for program-level factors, including the stratification variable for randomization.
  
  
  RESULTS
  In 2016, FIRST trial participants were 4,363 general surgery residents. Mean American Board of Surgery In-Training Examination scores for residents were not significantly different between study groups (Flexible Policy vs Standard Policy) overall (Flexible Policy: mean [SD] 502.6 [100.9] vs Standard Policy: 502.7 [98.6]; p = 0.98) or for any individual postgraduate year level. There was no difference in pass rates between study arms for either the Qualifying Examination (Flexible Policy: 90.4% vs Standard Policy: 90.5%; p = 0.99) or Certifying Examination (Flexible Policy: 86.3% vs Standard Policy: 88.6%; p = 0.24). Results from adjusted analyses were consistent with these findings.
  
  
  CONCLUSIONS
  Flexible, less-restrictive duty hour policies were not associated with differences in general surgery resident performance on examinations during the FIRST Trial. However, more years under flexible duty hour policies might be needed to observe an effect.
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Eddie
authors.initials: E
authors.lastname: Blay
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: D Brock
authors.initials: DB
authors.lastname: Hewitt
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jeanette W
authors.initials: JW
authors.lastname: Chung
authors.affiliation: American Board of Surgery, Philadelphia, PA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Biester
authors.affiliation: American Board of Surgery, Philadelphia, PA.
authors.forename: James F
authors.initials: JF
authors.lastname: Fiore
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Dahlke
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Quinn
authors.affiliation: American Board of Surgery, Philadelphia, PA.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lewis
authors.affiliation: Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, 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: D002568:Certification / Q000592:standards / Q000706:statistics & numerical data*; D004521:Educational Measurement / Q000706:statistics & numerical data*; D013502:General Surgery / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D016014:Linear Models; D016015:Logistic Models; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014481:United States; D016526:Workload / Q000592:standards*