The American Journal of Surgery
Volume 191, Issue 4 , Pages 527-532, April 2006

Work-hour restrictions as an ethical dilemma for residents

Presented at the 2005 Surgical Education Week, New York, NY, March 29–April 2, 2005

  • Robert O. Carpenter, M.D.

      Affiliations

    • Department of General Surgery, Vanderbilt University Medical Center, D-4311, Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2730, USA
    • Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1-615-343-9486; fax: +1-615-343-9485
    • ,
  • Mary T. Austin, M.D.

      Affiliations

    • Department of General Surgery, Vanderbilt University Medical Center, D-4311, Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2730, USA
    • ,
  • John L. Tarpley, M.D.

      Affiliations

    • Department of General Surgery, Vanderbilt University Medical Center, D-4311, Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2730, USA
    • ,
  • Marie R. Griffin, M.D., M.P.H.

      Affiliations

    • Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
    • ,
  • Kimberly D. Lomis, M.D.

      Affiliations

    • Department of General Surgery, Vanderbilt University Medical Center, D-4311, Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2730, USA

Received 12 April 2005; received in revised form 5 January 2006

Abstract 

Background

We propose that the standardized work-hour limitations have created an ethical dilemma for residents.

Methods

A survey tool was designed to assess factors that influence the number of hours residents work and report. The program directors of pediatrics, internal medicine, and general surgery at our institution supported their residents’ participation. A voluntary, anonymous survey of these residents was performed.

Results

One hundred seventy of 265 eligible residents were surveyed. Eighty-one percent of residents surveyed responded. Eighty percent of respondents reported exceeding work-hour restrictions at least once within the past 6 months. The factor of greatest influence measured was concern for patient care (80%). Forty-nine percent of respondents admitted underreporting their work hours.

Conclusions

The Accreditation Council for Graduate Medical Education work-hour restrictions have created an ethical dilemma for residents. Our data show that a significant number of residents feel compelled to exceed work-hour regulations and report those hours falsely.

Keywords:  Resident training , Education , Ethical dilemma , Underreporting , Work hours , Regulations , Patient safety

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 Supported in part by a grant from the Agency for Healthcare Research and Quality (T32 HS 13833) through the Vanderbilt Department of Preventive Medicine.

PII: S0002-9610(06)00005-5

doi:10.1016/j.amjsurg.2006.01.002

The American Journal of Surgery
Volume 191, Issue 4 , Pages 527-532, April 2006

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