This month’s journal club was written by Andrew Rogers, MS4 looking at the advanced online publication of the article: National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training by Bilimoria KY, Chung JW, Hedges LV, et al with a follow up perspective that can be found here.

The ACGME duty hour regulations have been a hotly debated issue since their implementation. Originally employed over concerns for patient safety there has been little direct evidence on improvement in patient outcomes. However, recently there has been an increase in focus on resident job satisfaction and the prevention of burnout. While the FIRST Trial does not report a significant difference in patient outcomes, should we prioritize and establish a work/life balance for residency?

Published this month were the results of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. Here we will discuss the results and their implications. Please comment below.

  • Are the outcome results surprising and do they reflect your own experiences and observations?
  • Are the resident satisfaction results surprising and do they reflect your experiences and observations?
  • How much “weight” should we place on patient outcomes when creating duty-hours policies? Should we consider a work-life balance for residents?
  • In perspectives article an ethical question was raised. Do you think it was ethical to conduct this trial without the consent of the residents and patients?

1. Bilimoria KY, Chung JW, Hedges LV, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med. 2016. doi:10.1056/NEJMoa1515724.

2. Rosenbaum L. Leaping without Looking – Duty Hours, Autonomy, and the Risks of Research and Practice. N Engl J Med. 2016. doi:10.1056/NEJMp1600233.

Leave a Reply

Your email address will not be published.