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diagnose, manage, and treat patients with surgical problems? Many professionals
involved in teaching learners would argue that surgical residents learn at different
rates depending on the task and the characteristics of the learner, and so a one size
fits all, time-based approach is too narrow.
As surgeons we have all been exposed to the aphorisms of our elders, which usu-
ally sound something like this. “The problem with being on call only every other
night is that you miss half of the good cases!” In this staid witticism is the assump-
tion that spending more time in the care of patients results in a greater breadth and
depth of knowledge that will ultimately make one a better surgeon. The other unfor-
tunate assumption is that unless you spend extraordinary hours in the care of
patients, you will not be as prepared as you could be (or should be) for the chal-
lenges of a surgical career. As stated in a commentary written in the Journal of the
American Medical Association, “Extensive duty hours are a necessary component
of resident education and a public symbol of a profession that requires hard work
and dedication.” [ 4 ].
It was common knowledge that the work hours for residents often exceeded
80 hours per week, and this was especially true of surgical training programs. In the
historical past, residents often lived in the hospitals where they trained (hence the
origin of the name “residents”) taking call every other night. While in the more
modern era, the situation is not that extreme, for all intents and purposes there was
only incremental change. In a cross-sectional study conducted by the ACGME of
weekly work hours by a postgraduate year PGY-1 and PGY-2 residents across mul-
tiple specialties, it was found that general surgery residents worked on average
102–105 hours per week. Eighty-nine percent of residents exceeded the “80-hour”
workweek [ 5 ]. Similar violations of the 80-h workweek were seen in neurologic
surgery (110 h per week), orthopedic surgery (93 h per week), urology (98 h per
week), and obstetrics- gynecology (91 h per week). Resident physicians more likely
to have higher than average work hours included those who were male, single,
childless, and at the PGY-1 level. Conversely, those with lower than average work
hours included PGY-2 level, married residents, those with children, and female resi-
dents. Other studies corroborate this data [ 6 ].
There are certainly detrimental effects to spending long hours performing the
work required of a resident physician. The realm of cognitive and psychomotor
performance, sleep deprivation has been well studied. In 1971, Friedman et al. pub-
lished a study that demonstrated after sleep deprivation of an actual night on call;
interns made significantly more errors interpreting an electrocardiogram than when
they were in a rested state [ 7 ]. More recent work has shown that sleep deprivation
can lead to increased serious medical errors in residents when they are actually
practicing medicine, as opposed to in simulated medical scenarios. In the study by
Landrigan et al., they observed the incidence of medical errors made by internal
medicine interns who worked in the medical intensive care unit and cardiac inten-
sive care unit [ 8 ]. In the traditional model of resident work hours, interns worked
77–81 h per week with up to 34 h of continuous duty; in contrast, the intervention
group worked 60–63 h per week with up to 16 h of continuous duty. Interns that
D.J. Rea and M. Smith