John R. Potts III, MD, FACS,
senior vice-president, surgical
accreditation, ACGME
Dr. Lewis Dr. Bilimoria
V101 No 3 BULLETIN American College of Surgeons
8 |
education community believe that the duty hour restrictions may
limit surgical training by inhibiting residents’ ability to follow
the natural history and progress of their patients.
FIRST Trial design
To determine whether modified restrictions on resident work
hours would affect patient care, surgical outcomes, and resident perceptions, the ACS, ABS, and ACGME undertook the
FIRST Trial. Karl Y. Bilimoria, MD, MS, FACS, ACS Faculty
Scholar and director, Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg
School of Medicine, Chicago, IL, served as the lead investigator of the study, which involved 117 ACGME-approved U.S.
general surgery residency programs and their 151 affiliated
hospitals. (See sidebar, this page, for a list of other study leaders.) These institutions represent 95 percent of the programs
that were eligible to participate in the study and were randomly assigned to either an intervention group with flexible
duty hours or a control group. To gauge trainee satisfaction,
we administered a survey at the January 2015 ABS In-Training
Examination (ABSITE).
Both groups of training institutions that participated in the
FIRST Trial adhered to ACGME policies, limiting the workweek
to an average of 80 hours; residents on average got one day off
per week, and residents could take call no more often than every
third night. The Standard Policy control group, composed of
59 training programs and 71 affiliated hospitals, also complied
with all ACGME mandates from 2003 and 2011 described previously. The 58 training programs and 80 affiliate hospitals in
the Flexible Policy group received permission from the ACGME
to waive the rules pertaining to intern work shifts, duty hours
for senior residents, time off between shifts, and time off after
24 hours of continuous duty.
EXECUTIVE DIRECTOR’S REPORT
FIRST TRIAL LEADERS
Northwestern University
Karl Y. Bilimoria, MD, MS, FACS,
FIRST Trial Principal Investigator
Jeanette W. Chung, PhD,
Research assistant professor
American College of Surgeons
Mark E. Cohen, PhD,
Senior Statistician/Data Analyst,
Division of Research and Optimal
Patient Care
David B. Hoyt, MD, FACS,
Executive Director
Clifford Y. Ko, MD, MS, MSHS, FACS,
Director, ACS NSQIP
American Board of Surgery
Frank R. Lewis, MD, FACS, executive
director
