If you have comments or suggestions about this or other issues, please
send them to Dr. Hoyt at email@example.com.
Using the ACS National Surgical Quality Improvement Program (ACS NSQIP®) platform to measure
death or serious morbidity within 30 days of an operation, we found that of the nearly 139,000 patients who
underwent surgery, the rate of this composite outcome was similar in both study groups (9 percent).
We also found no differences between study arms
for the 10 other patient outcomes studied, including
the need for a second operation.
Furthermore, among the 4,330 residents who
responded to the ABSITE survey, those trainees in
the flexible group ( 2,220 respondents) reported no significant difference in their overall well-being compared
with residents in the control group ( 2,110). There also
was no difference between the first two study arms
with respect to resident satisfaction with duty hours
at their program and with job satisfaction.
Residents in the Flexible Policy group were more
likely than participants in the Standard Policy group
to report improved continuity of patient care, patient
safety, acquisition of operative skills, and professionalism. Residents in the flexible work hour group
also were more likely to report being present for the
entirety of an operation and being able to treat their
patients through critical times without interruption
due to duty hour limits.
The FIRST Trial results were announced February 2
at the Academic Surgical Congress in Jacksonville, FL,
hosted by the Association for Academic Surgery and
the Society of University Surgeons.
For further details about the FIRST Trial, see the
article on page 53, or visit facs.org/media/first-trial.
A way forward
The FIRST Trial is a landmark study because it provides the first evidence we have to show that modifying work hours is safe and actually may enhance the
surgical learning environment. And I think it’s good
news for patients because they are going to have physicians following them throughout the entire episode
In light of the FIRST Trial findings, the ACGME
has agreed to review its work hour policies. I am confident that the ACS, ABS, ACGME, and the American
Board of Medical Specialties—which recently issued
a statement supporting the FIRST Trial—will be able
to use this initiative to develop new consensus-based
protocols for resident work hours.
Overall, this study and its likely effects provide a
great example of how professional organizations that
are committed to setting standards for surgical education and patient care can work together to resolve
issues of mutual concern. As always, we welcome your
suggestions on how we can help you provide quality
surgical care to your patients. ♦
The audience at the FIRST Trial results announcement