Study examines effects of duty-hour
reforms on surgical patients
The duty-hour reforms that the Accreditation Council for Graduate Medical Education
imposed in 2011, which limit resident work hours to 80 per week, have had no
significant effect on the outcomes for general surgery patients, according to a study in
the December 10 issue of the Journal of the American Medical Association (JAMA).
Ravi Rajaram, MD, ACS Clinical Scholar in Residence and a fourth-year resident in general
surgery at Northwestern Medicine, Chicago, IL, conducted the study to determine the effects
of the controversial 2011 ACGME duty-hour reforms. Karl Bilimoria, MD, MS, FACS, Faculty
Scholar at the American College of Surgeons (ACS); director, Surgical Outcomes and Quality
Improvement Center, and vice-chair for quality, department of surgery, Feinberg School of
Medicine, Northwestern University, was the senior author of the study. ACS Executive Director
David B. Hoyt, MD, FACS, and Clifford Y. Ko, MD, MS, MSHS, FACS, Director of the ACS Division
of Research and Optimal Patient Care and the ACS National Surgical Quality Improvement
Program (ACS NSQIP®), were co-authors. The authors used data from ACS NSQIP.
The study examined general surgery patient outcomes two years before (academic years
2009–2010) and after (academic years 2012–2013) the 2011 duty-hour reform, and no difference in
outcomes was observed for any of the postoperative complications studied. General surgery resident
performance on the annual in-training written board and oral board examinations was assessed
for this same period. Similarly, the reforms had no observable impact on exam performance.
The prospective Flexibility In duty hour Requirements for Surgical Trainees Trial (FIRST Trial),
sponsored by the ACS, the American Board of Surgery, and the ACGME, will provide further evidence
to guide surgical residency duty-hour policies. View more information about the FIRST Trial at www.
thefirsttrial.org/. Dr. Bilimoria noted that certain duty-hour restrictions offer no benefits to patient care
and have the unintended consequence of hurting patient safety, resident education, and the physician-
patient relationship. The authors also noted that increased handoffs, trainees feeling unprepared to
practice, and concern regarding residents developing a shift-work mentality engendered by these
duty-hour policies suggest the need for revision or reconsideration of the duty-hour reform.
View the JAMA article at http://media.jamanetwork.com/news-item/resident-duty-hour-
examination-scores/ and a related commentary co-authored by James C. Hebert, MD, FACS,
Burlington, VT, a former ACS Governor, and former chair of ACGME’s Surgery Residency
Review Committee, at http://jama.jamanetwork.com/article.aspx?articleid=2020355. ♦
Jacobson Promising Investigator Award
deadline extended to March 27
The application deadline for the 2015 Joan L. and Julius H. Jacobson II Promising Investigator
Award has been extended to March 27, 2015. The award recognizes outstanding surgeons who
engage in research, advance the art and science of surgery, and demonstrate early promise of
significant contribution to the practice of surgery and the safety of surgical patients. Visit www.
facs.org/quality-programs/about/cqi/jacobson to view details and selection criteria for the award. ♦