National cluster-randomized trial of duty-hour flexibility in surgical training

Karl Y. Bilimoria, Jeanette W. Chung, Larry V. Hedges, Allison R. Dahlke, Remi Love, Mark E. Cohen, David B. Hoyt, Anthony D. Yang, John L. Tarpley, John D. Mellinger, David M. Mahvi, Rachel R. Kelz, Clifford Y. Ko, David D. Odell, Jonah J. Stulberg, Frank R. Lewis

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P = 0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P = 0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexiblepolicy group and 10.7% in the standard-policy group, P = 0.86) or well-being (14.9% and 12.0%, respectively; P = 0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).

Original languageEnglish (US)
Pages (from-to)713-727
Number of pages15
JournalNew England Journal of Medicine
Volume374
Issue number8
DOIs
StatePublished - Feb 25 2016
Externally publishedYes

Fingerprint

Patient Safety
Education
Pragmatic Clinical Trials
Graduate Medical Education
Continuity of Patient Care
Mortality
Accreditation
Patient Education
Internship and Residency
Fatigue
Patient Care
Odds Ratio
Confidence Intervals
Professionalism

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bilimoria, K. Y., Chung, J. W., Hedges, L. V., Dahlke, A. R., Love, R., Cohen, M. E., ... Lewis, F. R. (2016). National cluster-randomized trial of duty-hour flexibility in surgical training. New England Journal of Medicine, 374(8), 713-727. https://doi.org/10.1056/NEJMoa1515724

National cluster-randomized trial of duty-hour flexibility in surgical training. / Bilimoria, Karl Y.; Chung, Jeanette W.; Hedges, Larry V.; Dahlke, Allison R.; Love, Remi; Cohen, Mark E.; Hoyt, David B.; Yang, Anthony D.; Tarpley, John L.; Mellinger, John D.; Mahvi, David M.; Kelz, Rachel R.; Ko, Clifford Y.; Odell, David D.; Stulberg, Jonah J.; Lewis, Frank R.

In: New England Journal of Medicine, Vol. 374, No. 8, 25.02.2016, p. 713-727.

Research output: Contribution to journalArticle

Bilimoria, KY, Chung, JW, Hedges, LV, Dahlke, AR, Love, R, Cohen, ME, Hoyt, DB, Yang, AD, Tarpley, JL, Mellinger, JD, Mahvi, DM, Kelz, RR, Ko, CY, Odell, DD, Stulberg, JJ & Lewis, FR 2016, 'National cluster-randomized trial of duty-hour flexibility in surgical training', New England Journal of Medicine, vol. 374, no. 8, pp. 713-727. https://doi.org/10.1056/NEJMoa1515724
Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME et al. National cluster-randomized trial of duty-hour flexibility in surgical training. New England Journal of Medicine. 2016 Feb 25;374(8):713-727. https://doi.org/10.1056/NEJMoa1515724
Bilimoria, Karl Y. ; Chung, Jeanette W. ; Hedges, Larry V. ; Dahlke, Allison R. ; Love, Remi ; Cohen, Mark E. ; Hoyt, David B. ; Yang, Anthony D. ; Tarpley, John L. ; Mellinger, John D. ; Mahvi, David M. ; Kelz, Rachel R. ; Ko, Clifford Y. ; Odell, David D. ; Stulberg, Jonah J. ; Lewis, Frank R. / National cluster-randomized trial of duty-hour flexibility in surgical training. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 8. pp. 713-727.
@article{9b192fb890f842cdb59fcd505c90e223,
title = "National cluster-randomized trial of duty-hour flexibility in surgical training",
abstract = "BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1{\%} in the flexible-policy group and 9.0{\%} in the standard-policy group, P = 0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92{\%} confidence interval, 0.87 to 1.06; P = 0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0{\%} in the flexiblepolicy group and 10.7{\%} in the standard-policy group, P = 0.86) or well-being (14.9{\%} and 12.0{\%}, respectively; P = 0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0{\%} vs. 13.2{\%}, P<0.001) or handing off active patient issues (32.0{\%} vs. 46.3{\%}, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).",
author = "Bilimoria, {Karl Y.} and Chung, {Jeanette W.} and Hedges, {Larry V.} and Dahlke, {Allison R.} and Remi Love and Cohen, {Mark E.} and Hoyt, {David B.} and Yang, {Anthony D.} and Tarpley, {John L.} and Mellinger, {John D.} and Mahvi, {David M.} and Kelz, {Rachel R.} and Ko, {Clifford Y.} and Odell, {David D.} and Stulberg, {Jonah J.} and Lewis, {Frank R.}",
year = "2016",
month = "2",
day = "25",
doi = "10.1056/NEJMoa1515724",
language = "English (US)",
volume = "374",
pages = "713--727",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "8",

}

TY - JOUR

T1 - National cluster-randomized trial of duty-hour flexibility in surgical training

AU - Bilimoria, Karl Y.

AU - Chung, Jeanette W.

AU - Hedges, Larry V.

AU - Dahlke, Allison R.

AU - Love, Remi

AU - Cohen, Mark E.

AU - Hoyt, David B.

AU - Yang, Anthony D.

AU - Tarpley, John L.

AU - Mellinger, John D.

AU - Mahvi, David M.

AU - Kelz, Rachel R.

AU - Ko, Clifford Y.

AU - Odell, David D.

AU - Stulberg, Jonah J.

AU - Lewis, Frank R.

PY - 2016/2/25

Y1 - 2016/2/25

N2 - BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P = 0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P = 0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexiblepolicy group and 10.7% in the standard-policy group, P = 0.86) or well-being (14.9% and 12.0%, respectively; P = 0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).

AB - BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P = 0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P = 0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexiblepolicy group and 10.7% in the standard-policy group, P = 0.86) or well-being (14.9% and 12.0%, respectively; P = 0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001). CONCLUSIONS As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).

UR - http://www.scopus.com/inward/record.url?scp=84959378432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959378432&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1515724

DO - 10.1056/NEJMoa1515724

M3 - Article

C2 - 26836220

AN - SCOPUS:84959378432

VL - 374

SP - 713

EP - 727

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 8

ER -