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http://www.nejm.org/doi/full/10.1056/NEJMoa1515724?query=featured_home
Doesn't appear to be paywalled.
In general, they found no statistical difference for patient outcomes, nor for resident health. There were 3X as many negative reports for those with the more "flexible" schedules on personal activities such as family/rest/etc, but apparently those don't reach significance on further statistical analysis that takes into account multiple comparison issues. They also reported better perceptions for the "flexible" group on aspects of patient care. These all rolled up to be no difference when aggregated into larger groups.
The study could be read both ways depending on your bias I believe. Either you could claim that flexibility doesn't seem to be causing any harm, so why not let programs have more flexibility where it is warranted OR you could claim that there is no difference to having all these extra handoffs, so why not go with a more stringent regime with a shorter duty hour length?
The thing that is not studied is long term educational value for the resident. Don't know that we can ever get that answer.
Here is the abstract for those who don't want to click.
BACKGROUND
Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being.
METHODS
We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014–2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care.
RESULTS
In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001).
CONCLUSIONS
As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents’ satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.)
Doesn't appear to be paywalled.
In general, they found no statistical difference for patient outcomes, nor for resident health. There were 3X as many negative reports for those with the more "flexible" schedules on personal activities such as family/rest/etc, but apparently those don't reach significance on further statistical analysis that takes into account multiple comparison issues. They also reported better perceptions for the "flexible" group on aspects of patient care. These all rolled up to be no difference when aggregated into larger groups.
The study could be read both ways depending on your bias I believe. Either you could claim that flexibility doesn't seem to be causing any harm, so why not let programs have more flexibility where it is warranted OR you could claim that there is no difference to having all these extra handoffs, so why not go with a more stringent regime with a shorter duty hour length?
The thing that is not studied is long term educational value for the resident. Don't know that we can ever get that answer.
Here is the abstract for those who don't want to click.
BACKGROUND
Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being.
METHODS
We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014–2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care.
RESULTS
In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety. Residents in the flexible-policy group were less likely than those in the standard-policy group to report leaving during an operation (7.0% vs. 13.2%, P<0.001) or handing off active patient issues (32.0% vs. 46.3%, P<0.001).
CONCLUSIONS
As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents’ satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.)