Nathan S Mauser1, James D Michelson1, Hannah Gissel2, Corey Henderson2, Cyril Mauffrey3. 1. Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Robert T. Stafford Hall, 4th Floor 95 Carrigan Drive, Burlington, VT, 05405-0084, USA. 2. Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. 3. Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. cmauffrey@yahoo.com.
Abstract
PURPOSE: The ACGME (US) and The European Working Time Directive (UK) placed work-hour restrictions on medical trainees with the goal of improved patient safety. However, there has been concern over a potential decrease in medical education. Orthopaedic training is the focus of this study. We examined previously published subjective and objective data regarding education and work-hour restrictions and developed the questions: Do specific perceptions emerge within the subjective studies examined? Are there objective differences in educational measures before and after work-hour restrictions? Is there a difference between the subjective and objective data? METHODS: A systematic review was conducted via MedLine, regarding orthopaedic studies in the USA and UK, with reference to work-hour restrictions and education. RESULTS: Subjective survey studies demonstrate that residents and attending physicians have a negative response to work-hour restrictions because of the perceived impact on their overall education and operating room experience. Conversely, limited objective studies demonstrated no change in operative volume before or after implementation of restrictions. CONCLUSIONS: This review highlights the need for more objective studies on the educational implications of work-hour restrictions. Studies to date have not demonstrated a measurable difference based on case logs or training scores. Opinion-based surveys demonstrate an overall negative perception by both residents and attending physicians, on the impact of work-hour restrictions on orthopaedic education. Current published data is limited and stronger evidence-based data are needed before definitive conclusions can be reached.
PURPOSE: The ACGME (US) and The European Working Time Directive (UK) placed work-hour restrictions on medical trainees with the goal of improved patient safety. However, there has been concern over a potential decrease in medical education. Orthopaedic training is the focus of this study. We examined previously published subjective and objective data regarding education and work-hour restrictions and developed the questions: Do specific perceptions emerge within the subjective studies examined? Are there objective differences in educational measures before and after work-hour restrictions? Is there a difference between the subjective and objective data? METHODS: A systematic review was conducted via MedLine, regarding orthopaedic studies in the USA and UK, with reference to work-hour restrictions and education. RESULTS: Subjective survey studies demonstrate that residents and attending physicians have a negative response to work-hour restrictions because of the perceived impact on their overall education and operating room experience. Conversely, limited objective studies demonstrated no change in operative volume before or after implementation of restrictions. CONCLUSIONS: This review highlights the need for more objective studies on the educational implications of work-hour restrictions. Studies to date have not demonstrated a measurable difference based on case logs or training scores. Opinion-based surveys demonstrate an overall negative perception by both residents and attending physicians, on the impact of work-hour restrictions on orthopaedic education. Current published data is limited and stronger evidence-based data are needed before definitive conclusions can be reached.
Entities:
Keywords:
Education; Orthopaedic resident; Restrictions; Work hours
Authors: Sharat K Kusuma; Samir Mehta; Michael Sirkin; Adolph J Yates; Theodore Miclau; Kimberly J Templeton; Gary E Friedlaender Journal: J Bone Joint Surg Am Date: 2007-03 Impact factor: 5.284
Authors: Alan H Daniels; Matthew McDonnell; Christopher T Born; Roman A Hayda; Michael G Ehrlich; Peter G Trafton; Staci A Fischer; Christopher W Digiovanni Journal: J Bone Joint Surg Am Date: 2013-08-07 Impact factor: 5.284
Authors: Miranda J Rogers; Michelle Zeidan; Zachary S Flinders; Angela P Presson; Robert Burks Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2019-04-30
Authors: Jeffrey J Olson; Bo Zhang; Diana Zhu; Evan T Zheng; George S M Dyer; Tamara D Rozental; Dawn M LaPorte Journal: JB JS Open Access Date: 2021-02-19