Effect of the 16-hour work limit on general surgery intern operative case volume: A multi-institutional study

Samuel I. Schwartz, Joseph M Galante, Amy Kaji, Matthew Dolich, David Easter, Marc L. Melcher, Kevin Patel, Mark E. Reeves, Ali Salim, Anthony J. Senagore, Danny M. Takanishi, Christian De Virgilio

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

IMPORTANCE: The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE: To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAINOUTCOMESAND MEASURES: Total, major, first-assistant, and defined-category case totals. RESULTS: As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P =.005), a 31.8% decrease in major cases (54.9 vs 80.5, P <.001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P =.008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE: The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

Original languageEnglish (US)
Pages (from-to)829-833
Number of pages5
JournalJAMA Surgery
Volume148
Issue number9
DOIs
StatePublished - Sep 2013

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Laparoscopy
Graduate Medical Education
Accreditation
Internship and Residency
Abdomen
Endoscopy
Blood Vessels
Pancreas
Breast
Neck
Thorax
Head
Pediatrics
Liver
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of the 16-hour work limit on general surgery intern operative case volume : A multi-institutional study. / Schwartz, Samuel I.; Galante, Joseph M; Kaji, Amy; Dolich, Matthew; Easter, David; Melcher, Marc L.; Patel, Kevin; Reeves, Mark E.; Salim, Ali; Senagore, Anthony J.; Takanishi, Danny M.; De Virgilio, Christian.

In: JAMA Surgery, Vol. 148, No. 9, 09.2013, p. 829-833.

Research output: Contribution to journalArticle

Schwartz, SI, Galante, JM, Kaji, A, Dolich, M, Easter, D, Melcher, ML, Patel, K, Reeves, ME, Salim, A, Senagore, AJ, Takanishi, DM & De Virgilio, C 2013, 'Effect of the 16-hour work limit on general surgery intern operative case volume: A multi-institutional study', JAMA Surgery, vol. 148, no. 9, pp. 829-833. https://doi.org/10.1001/jamasurg.2013.2677
Schwartz, Samuel I. ; Galante, Joseph M ; Kaji, Amy ; Dolich, Matthew ; Easter, David ; Melcher, Marc L. ; Patel, Kevin ; Reeves, Mark E. ; Salim, Ali ; Senagore, Anthony J. ; Takanishi, Danny M. ; De Virgilio, Christian. / Effect of the 16-hour work limit on general surgery intern operative case volume : A multi-institutional study. In: JAMA Surgery. 2013 ; Vol. 148, No. 9. pp. 829-833.
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abstract = "IMPORTANCE: The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE: To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAINOUTCOMESAND MEASURES: Total, major, first-assistant, and defined-category case totals. RESULTS: As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8{\%} decrease in total operative cases (65.9 vs 88.8, P =.005), a 31.8{\%} decrease in major cases (54.9 vs 80.5, P <.001), and a 46.3{\%} decrease in first-assistant cases (11.1 vs 20.7, P =.008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE: The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.",
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AU - Kaji, Amy

AU - Dolich, Matthew

AU - Easter, David

AU - Melcher, Marc L.

AU - Patel, Kevin

AU - Reeves, Mark E.

AU - Salim, Ali

AU - Senagore, Anthony J.

AU - Takanishi, Danny M.

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N2 - IMPORTANCE: The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE: To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAINOUTCOMESAND MEASURES: Total, major, first-assistant, and defined-category case totals. RESULTS: As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P =.005), a 31.8% decrease in major cases (54.9 vs 80.5, P <.001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P =.008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE: The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

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