Surgeons as Educators A Guide for Academic Development and Teaching Excellence

180

more of a negative effect on their morale, job satisfaction, career satisfaction, and
professionalism when compared to those in the standard policy duty-hour cohort.
This effect decreased as the PGY year increased so that senior-level residents in the
flexible-policy group perceived that the duty hours had less of a negative effect on
their morale, job satisfaction, career satisfaction, and professionalism when com-
pared the standard policy arm.
As shown in Fig. 9.2, the majority of residents in the flexible policy arm pre-
ferred a flexible duty-hour policy compared to only a minority of residents in the
standard policy arm. As the PGY level increased, the proportion of residents who
preferred a flexible policy increased dramatically. This was especially evident in the
group already assigned to the flexible duty-hour policy (increasing from 41% of
interns to 77% of senior residents). It seems that residents themselves overwhelm-
ingly want to train under a flexible duty-hour system, despite their own perceptions
that the flexible duty hours have had a negative effect on specific aspects of their
out-of-hospital well-being (e.g., rest, health, etc.). As discussed in this article, it
would appear that the benefits of this type of training – increased patient safety, bet-
ter continuity of care, and time in the operating room  – would outweigh the
negative.
The FIRST trial has caused controversy among those in surgical education as it
calls for broad changes in the way duty-hour restrictions are applied and enforced.

100

90

80

70

60

50

% Response^40

30

20

10

0

ALL RESIDENTS PGY1 PGY2-3

Flexible

Policy

Standard

Policy

Flexible

Policy

Standard

Policy

Prefer Flexible Policy Neutral

Flexible

Policy

Standard

Policy

PGY4-5

Flexible

Policy

Standard

Policy

Fig. 9.2 Resident perceptions of flexible duty hours

D.J. Rea and M. Smith