Journal of the American College of Surgeons
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Randomized Controlled Trial
Differences in Resident Perceptions by Postgraduate Year of Duty Hour Policies: An Analysis from the Flexibility in Duty hour Requirement for Surgical Trainees (FIRST) Trial.
In the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, there were several differences in residents' perceptions of aspects of their education, well-being, and patient care that differed between standard and flexible duty hour policies. Our objective was to assess whether these perceptions differed by level of training. ⋯ As PGY level increased, residents had increasing concerns about patient care and resident education and training under standard duty hour policies, but they had decreasing concerns about well-being under flexible policies. When given the choice between training under standard or flexible duty hour policies, only 14% of residents expressed a preference for standard policies.
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Randomized Controlled Trial
Association between Flexible Duty Hour Policies and General Surgery Resident Examination Performance: A Flexibility in Duty hour Requirement for Surgical Trainees (FIRST) Trial Analysis.
Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared with current ACGME duty hour policy (Standard Policy). ⋯ Flexible, less-restrictive duty hour policies were not associated with differences in general surgery resident performance on examinations during the FIRST Trial. However, more years under flexible duty hour policies might be needed to observe an effect.
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Randomized Controlled Trial
Effect of Flexible Duty Hour Policies on Length of Stay for Complex Intra-Abdominal Operations: A Flexibility in Duty hour Requirement for Surgical Trainees (FIRST) Trial Analysis.
Changes to resident duty hour policies in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial could impact hospitalized patients' length of stay (LOS) by altering care coordination. Length of stay can also serve as a reflection of all complications, particularly those not captured in the FIRST trial (eg pneumothorax from central line). Programs were randomized to either maintaining current ACGME duty hour policies (Standard arm) or more flexible policies waiving rules on maximum shift lengths and time off between shifts (Flexible arm). Our objective was to determine whether flexibility in resident duty hours affected LOS in patients undergoing high-risk surgical operations. ⋯ Duty hour flexibility had no statistically significant effect on LOS in patients undergoing complex intra-abdominal operations.
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Efforts to improve healthcare quality involve profiling hospitals and providers. Whether cancer-specific measures can be used reliably for profiling purposes has not been reported. ⋯ Profiling hospitals based on measures such as these can achieve acceptable reliability in reasonable timeframes, but does not always. Either lower levels of reliability should be accepted to profile surgeons with these measures or longer timeframes should be used.