2004 APDS SPRING MEETING: PART 3 Before and After Resident Work Hour Limitations: An Objective Assessment of the Well-being of Surgical Residents Thomas Stamp, MD, Paula Termuhlen, MD, Sidney Miller, MD, Dan Nolan, MS, Peter Hutzel, James Gilchrist, PhD, and R. Michael Johnson, MD Department of Surgery, Wright State University School of Medicine, Dayton, Ohio PURPOSE: To assess the impact of resident work hour limi- tations on how surgical residents feel about their training, pa- tient care, and their overall well-being. METHODS: Three surveys were administered to 28 categorical surgery residents before and after implementation of the Accredi- tation Council on Graduate Medical Education (ACGME) work hour restrictions. The surveys consisted of a Beck Depression In- ventory II (BDI-II), a SF-36 Health Status Profile (SF-36), and a custom 20-item Likert scale survey. The results of the surveys were then compiled to evaluate any significant changes in resident atti- tudes. RESULTS: Only minor differences were noted in the BDI-II and SF-36. The Likert scale survey showed no differences in attitude toward resident education, faculty interaction, operat- ing room exposure, patient care, or continuity. Significant im- provements were noted in the feelings of residents toward time for reading, rest, time with family, and socializing. CONCLUSIONS: Although a great deal of concern has ex- isted about the impact of work hour limitations on surgery resident training, residents feel their training has not been af- fected significantly. Work hour restrictions have, however, had a positive impact on the lives of surgery residents outside of the hospital. (Curr Surg 62:117–121. © 2005 by the Association of Program Directors in Surgery.) KEY WORDS: Work hour limitations, resident well-being, lifestyle, general surgery training INTRODUCTION Limits on resident work hours as mandated by New York State Public Health Law 405.4 and the Accreditation Council on Graduate Medical Education (ACGME) have sparked nation- wide debates regarding the implications on patient care, resi- dent training, and the overall state of Graduate Medical Edu- cation. 1-6 General surgery and surgical subspecialty training programs typically have the highest number of reported duty hours per week. 7 Many surgeons feel this large amount of time is paramount to adequate training. 1,4 However, the current generation of medical school graduates is showing a propensity toward “lifestyle-based” specialties such as radiology and anes- thesiology, which is evident in the decreasing rates of graduates seeking general surgery and surgical subspecialty careers wit- nessed before the enactment of the work hour limitations in July 2003. 9 Work hour limits will increase the amount of time surgery residents have away from the hospital, which should allow for more time for reading, social activities, and family. However, the impact of this reduction in time at the bedside and in the operating room on surgical training has yet to be seen. The purpose of this study was to assess the impact of resident work hour limitations on how surgical residents feel about their training, patient care, and their overall well-being. METHODS The general surgical residency at Wright State University is a 5-year integrated civilian and United States Air Force residency that is fully accredited by the Accreditation Council on Grad- uate Medical Education. Seven chief residents complete the program yearly. Wright State University is a community-based medical school. The hospitals involved in the residency include a 772-bed level 1 trauma center, a 560-bed level 2 trauma center, a 456-bed community hospital, a pediatric hospital, a United States Air Force Medical Center, and the Dayton Vet- erans Administration Medical Center. Twenty-nine categorical PGY 1-4 residents were eligible to complete the study, which permitted us to survey the same group of residents before and after initiation of the work hour restrictions. Twenty-eight res- idents completed both rounds of surveys. One resident chose not to take part as a study subject. Correspondence: Inquiries to Paula M. Termuhlen, MD, Department of Surgery, Wright State University, One Wyoming Street, Suite 7000, Dayton, OH 45409; fax: (937) 395- 8356; e-mail: paula.termuhlen@wright.edu CURRENT SURGERY • © 2005 by the Association of Program Directors in Surgery 0149-7944/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.cursur.2004.09.013 117