Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study | Medical Education and Training | JAMA Surgery | JAMA Network
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Original Investigation
Pacific Coast Surgical Association
September 2013

Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study

Author Affiliations
  • 1Department of Surgery, Harbor–University of California at Los Angeles Medical Center, Torrance
  • 2Department of Emergency Medicine, Harbor–University of California at Los Angeles Medical Center, Torrance
  • 3Department of Surgery, University of California at Davis, Sacramento
  • 4University of California, Irvine
  • 5University of California, San Diego
  • 6Stanford University, Stanford, California
  • 7Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
  • 8Loma Linda University Medical Center, Loma Linda, California
  • 9Cedars-Sinai Medical Center, Los Angeles, California
  • 10Keck Medical Center, University of Southern California, Los Angeles
  • 11University of Hawaii, Manoa
JAMA Surg. 2013;148(9):829-833. doi:10.1001/jamasurg.2013.2677

Importance  The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction.

Objective  To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience.

Design, Setting, and Participants  A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included.

Main Outcomes and Measures  Total, major, first-assistant, and defined-category case totals.

Results  As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases.

Conclusions and Relevance  The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.