Effect of Residency Duty-Hour Limits: Views of Key Clinical Faculty | Medical Education and Training | JAMA Network
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Original Investigation
July 23, 2007

Effect of Residency Duty-Hour Limits: Views of Key Clinical Faculty

Author Affiliations

Author Affiliations: Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota (Dr Reed); and Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Levine, Miller, Ashar, Bass, and Cofrancesco and Ms Rice).

Arch Intern Med. 2007;167(14):1487-1492. doi:10.1001/archinte.167.14.1487

Background  To determine the effect of duty-hour limitations, it is important to consider the views of faculty who have the most contact with residents.

Method  We conducted a national survey of key clinical faculty (KCF) at 39 internal medicine residency programs affiliated with US medical schools selected by random sample stratified by federal research funding and program size to elicit their views on the effect of duty-hour limitations on residents' patient care, education, professionalism, and well-being and on faculty workload and satisfaction.

Results  Of 154 KCF surveyed, 111 (72%) responded. The KCF reported worsening in residents' continuity of care (87%) and the physician-patient relationship (75%). Faculty believed that residents' education (66%) and professionalism, including accountability to patients (73%) and ability to place patient needs above self-interests (57%), worsened, yet 50% thought residents’ well-being improved. The KCF reported spending more time providing inpatient services (47%). Faculty noted decreased satisfaction with teaching (56%), ability to develop relationships with residents (40%), and overall career satisfaction (31%). In multivariate analysis, KCF with 5 years of teaching experience or more were more likely to perceive a negative effect of duty hours on residents' education (odds ratio, 2.84; 95% confidence interval, 1.15-7.00).

Conclusions  Key clinical faculty believe that duty-hour limitations have adversely affected important aspects of residents' patient care, education, and professionalism, as well as faculty workload and satisfaction. Residency programs should continue to look for ways to optimize experiences for residents and faculty within the confines of the duty-hour requirements.