169quality of patient care and a decrease in the continuity of care of their patients. They
also felt there was a decline in the case volume and a shifting of responsibility from
the junior residents to the senior residents.
A second study surveying residents on the cusp of the ACGME-mandated change
in resident duty hours also highlighted the potential positive and negative impacts of
the changes [ 23 ]. In a sampling of resident from programs in New England, the
majority of respondents to the survey were “happy” and “would choose surgery
again” if in medical school (81% and 78%, respectively). The majority felt that the
ACGME restrictions would have a positive or very positive effect on their personal
lives (82%) and work life (62%), while nearly 30% said that there would be a nega-
tive or very negative effect on patient care. Seventy-five percent of the junior-level
residents felt that “work hour limits would have a positive impact on resident work
life,” as compared to only 26% of the senior-level residents. Fifty-eight percent of
the junior-level residents felt that “work hour limits would have a positive impact on
patient care,” as compared to only 26% of the senior-level residents. When asked to
describe their “ideal” schedule, these residents thought that every fourth night on
call and 85–86 hours per week was preferred.
More detailed data was provided by Barden et al. from Weill Medical College in
New York City, as they reported on the outcomes of complying with the Bell
Commission recommendations as applied to their surgical residents before and after
the limitations [ 24 ]. As work hours decreased, they saw a statistically significant
increase in the ABSITE (American Board of Surgery In-Training Exam) score for
the junior residents, but this did not translate to a similar increase in performance for
the senior residents. Contrary to the data from the survey by Whang et al., the num-
ber of cases for the graduating senior residents actually increased after implement-
ing the 80-hour workweek. Additionally, it was felt that while there was an
improvement in resident quality of life, they felt that the continuity of care suffered
as a result. There was also a feeling by the residents and faculty that the limitation
of work hours did not improve basic science knowledge or clinical decision-mak-
ing. Sadly, the conclusion of this study was “that both residents and faculty have
serious concerns about the impact of work hour reductions on the quality of surgical
training and patient care,” suggesting that coming duty-hour reforms would be
viewed poorly by surgery educators and trainees.
Duty Hours in Non-US Training Programs
The issue of duty hours for resident physicians is not only an issue that became
important to trainees in the United States. The public concern over the details of the
Libby Zion case did have a ripple effect for other training programs in Western
European countries. Not all countries changed their practice policies quickly, how-
ever. Most of the changes in work hours in Canada, Europe, and elsewhere outside
of the United States are driven by issues surrounding resident well-being and fatigue
9 Resident Duty Hours in Surgical Education