Author Affiliations: Department of Internal
Medicine, Clement J. Zablocki VA Medical Center/Medical College of Wisconsin,
Milwaukee (Dr Fletcher); Ann Arbor Veterans Affairs Medical Center, Ann Arbor,
Mich (Drs Underwood and Saint); Departments of Urology (Dr Underwood) and
Internal Medicine (Drs Mangrulkar and McMahon), University of Michigan Medical
School, Ann Arbor; Department of Internal Medicine, University of Chicago
Pritzker School of Medicine, Chicago, Ill (Dr Davis).
Context The Accreditation Council for Graduate Medical Education implemented
mandatory work hour limitations in July 2003, partly out of concern for residents’
well-being in the setting of sleep deprivation. These limitations are likely
to also have an impact on other aspects of the lives of residents.
Objective To summarize the literature regarding the effect of interventions to
reduce resident work hours on residents’ education and quality of life.
Data Sources We searched the English-language literature about resident work hours
from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents,
supplemented with hand-search of additional journals, reference list review,
and review of abstracts from national meetings.
Study Selection Studies were included that assessed a system change designed to counteract
the effects of resident work hours, fatigue, or sleep deprivation; included
an outcome directly related to residents; and were conducted in the United
Data Extraction For each included study, 2 investigators independently abstracted data
related to study quality, subjects, interventions, and findings using a standard
data abstraction form.
Data Synthesis Fifty-four articles met inclusion criteria. The interventions used to
decrease resident work hours varied but included night and day float teams,
extra cross-coverage, and physician extenders. Outcomes included measures
of resident education (operative experience, test scores, satisfaction) and
quality of residents’ lives (amount of sleep, well-being). Interventions
to reduce resident work hours resulted in mixed effects on both operative
experience and on perceived educational quality but generally improved residents’
quality of life. Many studies had major limitations in their design or conduct.
Conclusions Past interventions suggest that residents’ quality of life may
improve with work hour limitations, but interpretation of the outcomes of
these studies is hampered by suboptimal study design and the use of nonvalidated
instruments. The long-term impact of reducing resident work hours on education
remains unknown. Current and future interventions should be evaluated with
more rigorous methods and should investigate links between residents’
quality of life and quality of patient care.
Fletcher KE, Underwood W, Davis SQ, Mangrulkar RS, McMahon LF, Saint S. Effects of Work Hour Reduction on Residents’ LivesA Systematic Review. JAMA. 2005;294(9):1088-1100. doi:10.1001/jama.294.9.1088