The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index; none of the 39 sources its claims cite is checked for support yet.
National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training
Open accessAbstract
BACKGROUND Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. METHODS We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. RESULTS In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7%…
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“There were no significant subgroup effects for death or serious complications according to type of surgery (emergency vs. elective), risk of death or serious complications (highest quartile vs. lower three quartiles of patients), or surgical setting (inpatient vs. outpatient) (Table S13 in the Supplementary Appendix).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“There were no significant subgroup effects for death or serious complications according to type of surgery (emergency vs. elective), risk of death or serious complications (highest quartile vs. lower three quartiles of patients), or surgical setting (inpatient vs. outpatient) (Table S13 in the Supplementary Appendix).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“There was no significant difference between study groups with respect to failure to rescue and renal failure, but the upper boundary of the 92% confidence interval exceeded the margin; therefore, noninferiority was not established for these outcomes.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“With respect to secondary outcomes, flexible policies were noninferior to standard policies with respect to serious complications, any complication, unplanned reoperation, sepsis, surgicalsite infection, and urinary tract infection in unadjusted and adjusted models (Fig. 1).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“There was no significant difference between study groups with respect to failure to rescue and renal failure, but the upper boundary of the 92% confidence interval exceeded the margin; therefore, noninferiority was not established for these outcomes.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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“All results were robust with respect to variations in modeling specifications and the inclusion of additional covariates for patients, hospitals, or both.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“The upper boundaries of the 92% confidence intervals from unadjusted and adjusted analyses of the 30-day rate of postoperative pneumonia coincided exactly with the noninferiority margin.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“The rate of death or serious complications did not differ significantly between study groups (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P = 0.92).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“The upper boundaries of the 92% confidence interval from both unadjusted and adjusted models were greater than 1.00 but less than the noninferiority margin odds ratio of 1.15; thus, flexible policies were deemed to be noninferior to standard policies with respect to death or serious complications.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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In the paper
“With respect to secondary outcomes, flexible policies were noninferior to standard policies with respect to serious complications, any complication, unplanned reoperation, sepsis, surgicalsite infection, and urinary tract infection in unadjusted and adjusted models (Fig. 1).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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- It may state two separate claims as one. 20
- Probably not a substantial claim. 21
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In the paper
“The results were inconclusive for 30-day mortality in the unadjusted analysis, but the noninferiority criterion was met in the adjusted analysis.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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“The results were qualitatively similar for conditional and population-averaged estimates (Table S34 in the Supplementary Appendix).”
- Also stated in: § Duty-Hour Flexibility in Surgical Tr aining · plain
“The results were qualitatively similar for conditional and population-averaged estimates (Table S35 in the Supplementary Appendix).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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- Also stated in: § Duty-Hour Flexibility in Surgical Tr aining · plain
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In the paper
“Thus, patient outcome analyses included 115 programs (58 in the standard-policy group and 57 in the flexiblepolicy group) and 148 hospitals (70 in the standard-policy group and 78 in the flexible-policy group), which contributed data on 138,691 general surgery patients (65,849 in the standard-policy group and 72,842 in the flexible-policy group).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Patient Outcomes
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“Our study sample included 117 ACGME-accredited general surgery residency programs and 151 affiliated hospitals (Fig. S1 in the Supplementary Appendix), because 1 program and 3 hospitals dropped out after randomization but before the trial start date.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Study Sample
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“Flexible-policy residents were significantly less likely than standard-policy residents to perceive a negative effect (vs. a positive effect or no effect) of institutional duty-hour policies on patient safety, continuity of care, clinical-skills acquisition, operative-skills acquisition, autonomy, operative volume, availability for elective and urgent cases, conference attendance, time for”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Duty-Hour Flexibility in Surgical Tr aining
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“Nonetheless, there were no significant differences between study groups regarding the perceived effects of duty hours on job satisfaction, satisfaction with career choice, or morale (Table 3).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Duty-Hour Flexibility in Surgical Tr aining
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In the paper
“Importantly, although there was a trend favoring standard policies with respect to outcomes related to perceptions of personal time, residents' satisfaction with overall wellbeing did not differ significantly between study groups.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
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In the paper
“However, residents reported that less-restrictive duty-hour policies had a negative effect on time with family and friends, time for extracurricular activities, rest, and health.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
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In the paper
“Flexible-policy residents did not report less satisfaction with their overall resident education, and they did not perceive that fatigue affected their personal safety or patient safety.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
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In the paper
“The number of policies waived at an institution was not associated with death or serious complications, nor were there any significant effects of waiving specific policies on death or serious complications.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Adherence Analyses
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In the paper
“When correction for multiple comparisons was applied, the differences in three resident outcomes were no longer significant between the standard-policy and flexible-policy groups: resident satisfaction with time for rest, perception of the quality and ease of handoffs and transitions in care, and perception of professionalism (P>0.0015 with correction for multiple comparisons, for all comparisons”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Duty-Hour Flexibility in Surgical Tr aining
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In the paper
“No data were collected regarding on-call schedules, duty-hour logs, sleep, midlevel providers, handoff protocols, or adherence to policies that remained unchanged across the two study groups (e.g., 80-hour workweek).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Statistical Analysis
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In the paper
“The ACS NSQIP data abstractors were not specifically informed of the study-group assignments.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Data Collection
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In the paper
“the Accreditation Council for Graduate Medical Education (ACGME) introduced national regulations in 2003 that limited resident duty periods to 80 hours per week, capped overnight shift lengths, and mandated minimum time off between shifts.1,2”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] 1. Accreditation Council for Graduate Medical Education. Resident duty hours in the learning and working environ- ment: comparison of 2003 and 2011 stan- dards (https:/ / www .acgme .org/ acgmeweb/ Portals/ 0/ PDFs/ dh-ComparisonTable2003 v2011 .pdf). source
- Not checked — no full text of the sourcecites [2] 2. Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA 2002; 288: 1112-4. source
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In the paper
“Primary resident outcome measures were specified before trial initiation and included residentreported level of satisfaction (very dissatisfied, dissatisfied, neutral, satisfied, or very satisfied) with overall quality of resident education and overall well-being.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Measures
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In the paper
“In a widely cited report on resident duty hours, the Institute of Medicine called for additional high-level research to inform policy.3”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not matchedcites [3] 3. Institute of Medicine. Resident duty hours: enhancing sleep, supervision, and safety. Washington, DC: National Acade- mies Press, 2008.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“Survey items were adapted from previous ly published surveys, pretested with residents through cognitive interviews, and iteratively revised.32”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Data Collection
What the sources say
- Not matchedcites [32] 32. Bilimoria KY, Chung JW, Hedges LV, et al. Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial protocol: a national cluster-randomized trial of resident duty hour policies. JAMA Surg 2015 December 30 (Epub ahead of print).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“Prespecified subgroup analyses tested for significant interactions between study-group assignment and subgroups defined according to resident sex, postgraduate year, program geographic region, and program type (academic, community, or military).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Statistical Analysis
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In the paper
“This study was a prospective, cluster-randomized, pragmatic, noninferiority trial comparing stan-dard ACGME duty-hour policies with flexible duty-hour policies.32”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Study Design and Oversight
What the sources say
- Not matchedcites [32] 32. Bilimoria KY, Chung JW, Hedges LV, et al. Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial protocol: a national cluster-randomized trial of resident duty hour policies. JAMA Surg 2015 December 30 (Epub ahead of print).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“in 2011, the ACGME implemented further restrictions to shorten maximum shift lengths for interns and increase time off after overnight on-call duty for residents.1,4,5”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] 1. Accreditation Council for Graduate Medical Education. Resident duty hours in the learning and working environ- ment: comparison of 2003 and 2011 stan- dards (https:/ / www .acgme .org/ acgmeweb/ Portals/ 0/ PDFs/ dh-ComparisonTable2003 v2011 .pdf). source
- Not checked — no full text of the sourcecites [4] 4. Nasca TJ, Day SH, Amis ES Jr. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010; 363(2): e3. source
- Not matchedcites [5] 5. Accreditation Council for Graduate Medical Education. The ACGME 2011 duty hour standards: enhancing quality of care, supervision, and resident professional devel- opment (http://www .acgme .org/ acgmeweb/ Portals/ 0/ PDFs/ jgme-monograph[1] .pdf).
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In the paper
“Residents were not specifically kept from knowing their studygroup assignment.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Randomization
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In the paper
“Response rates varied across survey items, ranging from 84 to 87% for the outcomes examined (Tables S25 through S30 in the Supplementary Appendix).”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Resident Outcomes
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In the paper
“critics cite a weak evidence base for the 2003 and 2011 reforms.3,6,7”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not matchedcites [3] 3. Institute of Medicine. Resident duty hours: enhancing sleep, supervision, and safety. Washington, DC: National Acade- mies Press, 2008.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [6] 6. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resi- dent duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259: 1041-53. source
- Not checked — no full text of the sourcecites [7] 7. Philibert I, Nasca T, Brigham T, Sha- piro J. Duty-hour limits and patient care and resident outcomes: can high-quality studies offer insight into complex rela- tionships? Annu Rev Med 2013; 64: 467-83. source
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In the paper
“Using an intention-to-treat approach, we modeled the association between patient outcomes and study-group assignment using threelevel hierarchical logistic-regression models with program-level and hospital-level random intercepts and controls for program-level strata of 2013 rates of postoperative death or serious”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Statistical Analysis
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In the paper
“Several retrospective studies and systematic reviews have questioned whether duty-hour reforms achieved their intended goals of improved patient outcomes, resident education, and resident well-being.[6][7][8][9][10][11][12][13][14][15][16][17][18]”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resi- dent duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259: 1041-53. source
- Not checked — no full text of the sourcecites [7] 7. Philibert I, Nasca T, Brigham T, Sha- piro J. Duty-hour limits and patient care and resident outcomes: can high-quality studies offer insight into complex rela- tionships? Annu Rev Med 2013; 64: 467-83. source
- Not matchedcites [8] 8. Rajaram R, Chung JW, Jones AT, et al. Association of the 2011 ACGME resident duty hour reform with general surgery pa- tient outcomes and with resident exami- nation performance. JAMA 2014; 312: 2374-84.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“However, many studies have suggested that dutyhour reforms resulted in improved well-being and less fatigue among surgical residents.6”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Abstract
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resi- dent duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259: 1041-53. source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, we conducted this study for a full academic year, but we cannot extrapolate the ways in which flexible duty-hour policies might affect the training and experience of an entire cohort of surgical residents over multiple years.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourth, our patient outcomes were limited to those captured in ACS NSQIP, so there may be other outcomes that would be more sensitive to resident duty-hour policies.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, patient outcomes could improve or worsen with more time under flexible duty-hour policies.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This suggests that the flexible, less-restrictive duty hours had their intended effect of improving continuity of care, as further reflected in the residents' perceptions of benefit with respect to continuity and patient safety in the intervention group.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, we focused on general surgery, and although our results may be relevant to other surgical disciplines, they may not be generalizable to nonsurgical specialties.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Previous surveys showed that residents were concerned about the negative effect of duty-hour policies on patient care and resident education; however, most generally did show improvements in residents' quality of life and well-being.6,16,19”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resi- dent duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259: 1041-53. source
- Not checked — no full text of the sourcecites [16] 16. Drolet BC, Christopher DA, Fischer SA. Residents' response to duty-hour regulations -a follow-up national survey. N Engl J Med 2012; 366(24): e35. source
- Not checked — no full text of the sourcecites [19] 19. Antiel RM, Reed DA, Van Arendonk KJ, et al. Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general sur- gery interns. JAMA Surg 2013; 148: 448- 55. source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, adherence to assigned study-group policies was evaluated on the basis of a survey of program directors and the policy changes implemented at that program.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given a noninferiority design with a 0.04 alpha level, 92% confidence intervals [100 × (1 -2α)] were used on the basis of a”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Resident Outcomes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given that ACS NSQIP already performs data-quality checks and audits (see the Supplementary Appendix), no additional data-quality checks were performed by the study team.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifth, although there was no significant difference between the standard-policy and flexible-policy groups in residents' report that fatigue affected personal safety, we did not specifically collect data on needle sticks and car accidents, because these are notoriously challenging outcomes to capture in surveys.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Residency program directors' reports accurately reflect the duty-hour policies followed at their institutions during the trial period.
“Program adherence was defined by residency program directors regarding which policies were followed at their institution during the trial period (100% response rate).”
The paper relies on this without support.
Policies that remained unchanged across the two study groups (e.g., the 80-hour workweek) were adhered to by programs.
“No data were collected regarding on-call schedules, duty-hour logs, sleep, midlevel providers, handoff protocols, or adherence to policies that remained unchanged across the two study groups (e.g., 80-hour workweek).”
The paper relies on this without support.
Resident survey responses accurately reflect residents' perceptions and experiences.
“Response rates varied across survey items, ranging from 84 to 87%.”
The paper relies on this without support.
The noninferiority margin (shaded region) used in the trial is clinically appropriate.
“Flexible policies were considered to be noninferior to standard policies if the estimated odds ratio (circle) and upper boundary of the 92% confidence interval are contained within the shaded region; inferior to standard policies if the estimated odds ratio and lower boundary of the 92% confidence interval are both to the right, outside the shaded region for an outcome; and superior to standard”
The paper relies on this without support.
The program-level strata based on 30-day rates of postoperative death or serious complications in 2013 is an adequate stratifying variable for the trial.
“with controls for program-level strata of 30-day rates of postoperative death or serious complications in 2013 (variable used in randomization)”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“In any case, neither of these studies suggested limiting work hours is harmful to patient safety.”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [17]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A limitation of several studies that informed this latest policy change is that the primary end points lacked sensitivity (eg, hospital-wide mortality) or were only tangentially related to the care provided by first-year resident physicians”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [19]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Several studies of the 16 hours 2011 ACGME work-hour limit found that it had no impact on hospital-level mortality or mortality following surgical procedures.”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The mortality rate following general surgery was not inferior at teaching hospitals allowed to exceed the 16 hours 2011 ACGME work-hour limit compared with hospitals assigned to follow those limits.17”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [17]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“a national, prospective, cluster-randomized trial of surgical residency programs that showed that surgical-complication and death rates were no worse under flexible duty-hour rules (without restrictions on shift length) than under standard rules.”
From Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine (2019) · cites this paper as [11]
The cited source says what the claim attributes to it.
In the citing paper
“In the FIRST (Flexibility in duty hour Requirements for Surgical Trainees) trial, first-year resident physicians at surgical programmes assigned to the flexible work-hour group were allowed to exceed 16 consecutive hours of work and required time off between shifts was reduced.17”
In the citing paper
“Paradoxically, residents given more time to sleep were more worried about decreases in their quality of work as a result of working less, yet they were more satisfied with the quality of their life and social functioning.”
From Sleep, Health, and Society (2017) · cites this paper as [223]
In the citing paper
“In a landmark study that compared 2 groups of residency programs, those that gave more time off for sleep did not show measurable changes in work performance.223”
From Sleep, Health, and Society (2017) · cites this paper as [223]
In the citing paper
“Paradoxically, residents given more time to sleep were more worried about decreases in their quality of work as a result of working less, yet they were more satisfied with the quality of their life and social functioning.”
From Sleep, Health, and Society (2017) · cites this paper as [223]
Citations
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Self-citationThe New Recommendations on Duty Hours from the ACGME Task Force
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New Requirements for Resident Duty Hours
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Flagged first, then by citations
Research works printed but not linked: 3
- Institute of Medicine. Resident duty hours: enhancing sleep, supervision, and safety. Washington, DC: National Academies Press, 2008.
- Rajaram R, BMJ Qual Saf
- Bilimoria KY, JAMA Surg
Cited by
Sorted by citations
Items 101–200 of 459
Surgery Resident Wellness Programs
Williams-Karnesky, R. L., Greenbaum, A. A., & Paul, J. S. (2020) · Advances in Surgery · doi:10.1016/j.yasu.2020.05.005 · Cited by 21
Vawter, K., Kuhn, S., Pitt, H. A., Wells, A. A., Jensen, H., & Mavros, M. N. (2023) · Surgery · doi:10.1016/j.surg.2023.07.023 · Cited by 20
Introductory Chapter: Developing Patient Safety Champions
Tolentino, J. C., Martins, N. B., Sweeney, J., Marchionni, C., Valenza, P., McGinely, T. C., Wojda, T. R., Firstenberg, M. S., & Stawicki, S. P. (2018) · InTech eBooks · doi:10.5772/intechopen.70582 · Cited by 20
Rice, M. K., Zenati, M. S., Novak, S. M., Abbas, A. I. A., Zureikat, A. H., Zeh, H. J., & Hogg, M. E. (2018) · Journal of surgical education · doi:10.1016/j.jsurg.2018.10.007 · Cited by 19
A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review
Coyle, A., Helenius, I. M., Cruz, C. M., et al. (2019) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-18-00596.1 · Cited by 19
Smith, B. K., Rectenwald, J. E., Yudkowsky, R., & Hirshfield, L. E. (2021) · JAMA Surgery · doi:10.1001/jamasurg.2021.0031 · Cited by 19
Lebares, C. C., Greenberg, A. L., Shui, A. M., Boscardin, C., & van der Schaaf, M. F. (2021) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205211020758 · Cited by 20
Antonoff, M. B., Nguyen, S., Nguyen, T. C., & Odell, D. D. (2018) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2018.09.117 · Cited by 19
Self-citationShea, J. A., Silber, J. H., Desai, S. V., Dinges, D. F., Bellini, L. M., Tonascia, J., Sternberg, A. L., Small, D. S., Shade, D. M., Katz, J. T., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021711 · Cited by 18
A narrative review of the impact of work hours and insufficient rest on job performance
Steffey, M. A., Risselada, M., Scharf, V. F., Buote, N. J., Zamprogno, H., Winter, A. L., & Griffon, D. J. (2023) · Veterinary Surgery · doi:10.1111/vsu.13943 · Cited by 25
Weaver, M. D., Sullivan, J. P., Landrigan, C. P., & Barger, L. K. (2023) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2023.06.014 · Cited by 22
Surgical Resident Duty-Hour Rules — Weighing the New Evidence
Birkmeyer, J. D. (2016) · New England Journal of Medicine · doi:10.1056/nejme1516572 · Cited by 18
Philibert, I. (2016) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-16-00642.1 · Cited by 18
The fatigue paradox: Team perceptions of physician fatigue
Field, E., Lingard, L. A., Cherry, R. A., Koughnett, J. A. V., DeLuca, S., & Taylor, T. (2021) · Medical Education · doi:10.1111/medu.14591 · Cited by 18
Robison, W., Patel, S. K., Mehta, A. J., et al. (2017) · Surgical Endoscopy · doi:10.1007/s00464-017-5820-6 · Cited by 18
Women in surgery: A longer term follow-up
Carter, J. V., Polk, H. C., Galbraith, N. J., McMasters, K. M., Cheadle, W. G., Poole, M., & Galandiuk, S. (2017) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2017.05.002 · Cited by 17
“Although duty hour restrictions may have negatively affected some aspects of training such as continuity of patient care ((15)), they may have made our own program and many other general surgery programs more favorable for attracting women and men to careers in surgery and general surgery specifically.”
BackgroundCumulative Effect of Flexible Duty-hour Policies on Resident Outcomes
Khorfan, R., Yuce, T. K., Love, R. R., Yang, A. D., Chung, J. W., Hoyt, D. B., Lewis, F. R., & Bilimoria, K. Y. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000003802 · Cited by 19
“In addition, during the FIRST Trial, residents in flexible duty-hour programs were more likely to report negative effects on time for family/friends, rest, and extracurricular activities.(1) It is unknown whether these effects are potentially worsened with increasing time under flexibility.”
BackgroundMethodResultInfluentialSelf-citationShort-Term Risk of Performing Concurrent Procedures with Hepatic Artery Infusion Pump Placement
Brajcich, B. C., Bentrem, D. J., Yang, A. D., et al. (2020) · Annals of Surgical Oncology · doi:10.1245/s10434-020-08938-0 · Cited by 17
Self-citationUnderstanding Ethical Challenges in Medical Education Research
Klitzman, R. L. (2022) · Academic Medicine · doi:10.1097/acm.0000000000004253 · Cited by 17
Sochacki, K. R., Dong, D., Peterson, L. E., McCulloch, P. C., & Harris, J. D. (2018) · JAAOS Global Research and Reviews · doi:10.5435/jaaosglobal-d-18-00065 · Cited by 16
Lessons Learned to Aid in Developing Fatigue Risk Management Plans for Resident Physicians
Kassam, A., Cowan, M., & Topps, M. H. (2018) · Teaching and Learning in Medicine · doi:10.1080/10401334.2018.1542307 · Cited by 16
Blackwell, T., Kriesel, D. R., Vittinghoff, E., O’Brien, C. S., Sullivan, J. P., Viyaran, N. C., Rahman, S. A., Lockley, S. W., Barger, L. K., Halbower, A. C., et al. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.03.005 · Cited by 16
“In that time a few studies have examined 2011 work hour reforms for interns (PGY1).”
InfluentialFatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand
Tucker, P. E., Cohen, P. A., Bulsara, M. K., & Acton, J. N. (2017) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12604 · Cited by 17
“Necessary Compromises”: A Qualitative Exploration of the Influence of Burnout on Resident Education
Lu, D. W., Germann, C. A., Nelson, S. W., Jauregui, J., & Strout, T. D. (2020) · AEM Education and Training · doi:10.1002/aet2.10500 · Cited by 16
Carayon, P., Kleinschmidt, P. C., Hose, B., & Salwei, M. E. (2020) · Springer eBooks · doi:10.1007/978-3-030-59403-9_7 · Cited by 22
Janczewski, L. M., Buchheit, J. T., Golisch, K. B., Amórtegui, D., Mackiewicz, N., Eng, J. S., Turner, P. L., Johnson, J. K., Bilimoria, K. Y., & Hu, Y. (2024) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000001135 · Cited by 18
Self-citationEthical implications of excessive cluster sizes in cluster randomised trials
Hemming, K., Taljaard, M., Forbes, G., Eldridge, S. M., & Weijer, C. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2017-007164 · Cited by 14
“27 Possible justifications include a desire to demonstrate sustainability, to estimate learning effects or to allow time for the intervention to become embedded in practice.”
The Measurement of Orthopaedic Surgeon Burnout Using a Validated Wearable Device
Sochacki, K. R., Dong, D., Peterson, L. E., McCulloch, P. C., & Harris, J. D. (2019) · Arthroscopy Sports Medicine and Rehabilitation · doi:10.1016/j.asmr.2019.09.004 · Cited by 15
“Given the incomplete understanding of sleep patterns and burnout following the work-hour restrictions and the increasing interest in physician and patient safety, it is important to understand the effects of sleep on orthopaedic surgeon burnout.(13,26) The purposes of this study were (1) to determine the prevalence of…”
BackgroundTo the Point: a prescription for well-being in medical education
Hopkins, L., Morgan, H. K., Buery-Joyner, S. D., Craig, L. B., Everett, E. N., Forstein, D. A., Graziano, S., Hampton, B. S., McKenzie, M. L., Page-Ramsey, S. M., et al. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.05.012 · Cited by 15
Gerull, K. M., Klein, S. E., Miller, A. N., & Cipriano, C. A. (2024) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000003015 · Cited by 14
“Satisfaction with lifestyle during residency was measured using an instrument with face validity that was re fi ned with cognitive interviews and used in studies on the lifestyle satisfaction of general surgery residents [10, 13, 20].”
Minami, C. A., Odell, D. D., & Bilimoria, K. Y. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2016.3198 · Cited by 14
“As per the Common Rule, human subjects research takes place when (1) data are obtained through intervention or interaction with a living individual or (2) identifiable private information regarding that individual is obtained.”
Self-citationRestrictions on surgical resident shift length does not impact type of medical errors
Anderson, J. E., Goodman, L. F., Jensen, G. W., Salcedo, E. S., & Galante, J. M. (2017) · Journal of Surgical Research · doi:10.1016/j.jss.2016.12.038 · Cited by 14
Team-based simulations for new surgeons: Does early and often make a difference?
AbdelFattah, K. R., Spalding, M. C., Leshikar, D. E., & Gardner, A. K. (2017) · Surgery · doi:10.1016/j.surg.2017.11.005 · Cited by 14
Pololi, L. H., Evans, A. T., Civian, J. T., Shea, S., & Brennan, R. T. (2018) · Journal of surgical education · doi:10.1016/j.jsurg.2018.04.021 · Cited by 14
What They Are Not Telling Us: Analysis of Nonresponders on a National Survey of Resident Well-Being
Cardell, C. F., Yuce, T. K., Zhan, T., Eng, J. S., Cheung, E. O., Etkin, C. D., Amórtegui, D., Jones, A. T., Buyske, J., Bilimoria, K. Y., et al. (2022) · Annals of Surgery Open · doi:10.1097/as9.0000000000000228 · Cited by 14
Self-citationBlay, E., Hewitt, B., Chung, J. W., Biester, T. W., Fiore, J. F., Dahlke, A. R., Quinn, C. M., Lewis, F. R., & Bilimoria, K. Y. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.10.042 · Cited by 14
Self-citationFatigue in Residency Education: Understanding the Influence of Work Hours Regulations in Europe
Taylor, T., Teunissen, P. W., Dornan, T., & Lingard, L. (2017) · Academic Medicine · doi:10.1097/acm.0000000000001831 · Cited by 13
Bilimoria, K. Y. (2020) · Journal of Surgical Research · doi:10.1016/j.jss.2020.06.005 · Cited by 13
Self-citationQuality Metrics and Indicators for Surgical Training: A Scoping Review
Shaban, L., Mkandawire, P., O’Flynn, E., Mangaoang, D., Mulwafu, W., & Stanistreet, D. (2023) · Journal of surgical education · doi:10.1016/j.jsurg.2023.06.023 · Cited by 13
Bennett, C. L., Finch, A. S., Vuong, K., McDonald, D. A., & Rennie, S. (2016) · New England Journal of Medicine · doi:10.1056/nejmc1604659 · Cited by 13
Multi-institutional Evaluation of Producing and Testing a Novel 3D-Printed Laparoscopic Trainer
Parkhomenko, E., Yoon, R., Okhunov, Z., et al. (2018) · Urology · doi:10.1016/j.urology.2018.06.034 · Cited by 13
Fatigue risk management systems needed in healthcare
Noone, P. A., & Waclawski, E. (2018) · Occupational Medicine · doi:10.1093/occmed/kqy101 · Cited by 14
Huatuco, R. M. P., Liaño, J. E., Moreno, L. B., et al. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.01.065 · Cited by 13
“The depletion rate was higher than the traditional rates reported in the literature [16,22,23].”
Mirmehdi, I., O'Neal, C.-M., Moon, D., MacNew, H. G., & Senkowski, C. K. (2016) · Journal of surgical education · doi:10.1016/j.jsurg.2016.07.015 · Cited by 13
A National Cross-Sectional Study of Surgery Residents Who Underreport Duty Hours
Bennett, C., McDonald, D. A., Chang, Y., Finch, A., Vuong, K., Rennie, S., & Nadel, E. S. (2017) · Journal of surgical education · doi:10.1016/j.jsurg.2017.05.008 · Cited by 12
Managing the Most Precious Resource in Medicine
McMahon, G. T. (2018) · New England Journal of Medicine · doi:10.1056/nejme1802899 · Cited by 12
“Data regarding the surgery group are from the FIRST trial.(4)”
Choi, S. H., Kuchta, K. M., Rojas, A. E., Mehdi, S. A., Barriga, M. R., Hays, S. B., Talamonti, M., & Hogg, M. E. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10216-5 · Cited by 12
“While MIS has been emerging, the climate in clinical environments for young trainees has changed resulting in decreased opportunities for operative exposure including increasing number of MIS fellowships, greater concern for medical errors with closer oversight, and shorter duty-hours [1, 2].”
Would you allow a sleepy surgeon operate on you? A narrative review.
Whelehan, D. F., Alexander, M., & Ridgway, P. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101341 · Cited by 11
Surgical Trainees’ Sense of Responsibility for Patient Outcomes: A Multi-institutional Appraisal
Randle, R. W., Ahle, S. L., Elfenbein, D. M., Hildreth, A. N., Lee, C. Y., Greenberg, J. A., Schenarts, P. J., & Kempenich, J. W. (2020) · Journal of Surgical Research · doi:10.1016/j.jss.2020.05.035 · Cited by 13
Strickland, B. A., Rāviņa, K., Kammen, A., Chang, S., Rutkowski, M. J., Donoho, D. A., Minneti, M., Jackanich, A., Bakhsheshian, J., & Zada, G. (2020) · Operative Neurosurgery · doi:10.1093/ons/opz424 · Cited by 12
Wang, H.-H., & Lin, Y. (2021) · Journal of Medical Internet Research · doi:10.2196/26763 · Cited by 12
“…hours in 2011 and then reverted back to 24 hours in 2017 following results of a randomized controlled trial published in 2016 showing that more flexible duty-hour policies resulted in noninferior patient outcomes and physicians’ self-reported well-being when compared with restrictive policies [4].”
ResultInfluentialThe Plastic Surgeon at Work and Play: Surgeon Health, Practice Stress, and Work–Home Balance
Bentz, M. L. (2016) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000001081 · Cited by 11
Working hours of obstetrics and gynaecology trainees in Australia and New Zealand
Acton, J. N., Tucker, P. E., Bulsara, M. K., & Cohen, P. A. (2017) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12605 · Cited by 12
Optimizing the Balance Between Supervision and Autonomy in Training
Happel, J. P., Ritter, J., & Neubauer, B. E. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.1250 · Cited by 12
Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing*
Bakhru, R. N., Basner, M., Kerlin, M. P., Halpern, S. D., Hansen-Flaschen, J. H., Rosen, I. M., Dinges, D. F., & Schweickert, W. D. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003773 · Cited by 11
Association of preoperative smoking with complications following major gastrointestinal surgery
Brajcich, B. C., Yuce, T. K., Merkow, R. P., Bilimoria, K. Y., McGee, M. F., Zhan, T., & Odell, D. D. (2021) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2021.06.002 · Cited by 11
Self-citationSurgical Residents’ Work Hours and Well-Being in Year 2 of the FIRST Trial
Dahlke, A. R., Quinn, C. M., Chung, J. W., & Bilimoria, K. Y. (2017) · New England Journal of Medicine · doi:10.1056/nejmc1703812 · Cited by 11
Self-citationTop Medical Education Studies of 2016: A Narrative Review
Fromme, H. B., Ryan, M. S., Darden, A., D’Alessandro, D. M., Mogilner, L. N., Paik, S., & Turner, T. L. (2018) · Academic Pediatrics · doi:10.1016/j.acap.2018.01.015 · Cited by 11
Li, R. D., Pillado, E. B., DiLosa, K. L., Chia, M. C., Visenio, M. R., Zhan, T., Eng, J. S., Amórtegui, D., Johnson, J. K., Sheahan, M. G., et al. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.12.003 · Cited by 10
Self-citationSterling, L., McCaffrey, C., Secter, M. B., Rich, R. L., Green, J., Shirreff, L., & Steele, D. (2016) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2016.06.015 · Cited by 10
Sekine, M., Nishijima, K., Nakagawa, S., et al. (2022) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15230 · Cited by 10
Assessing Resident Well-Being After the ABSITE: A Bad Time to Ask?
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Self-citationSee One, Do One, Improve One’s Wellness
Abahuje, E. A. E., Smith, K. S., Amórtegui, D., Eng, J. S., Philbin, S. E., Verma, R., Dastoor, J. D., Schlick, C. J. R., Ma, M., Mackiewicz, N. I., et al. (2023) · Annals of Surgery · doi:10.1097/sla.0000000000006002 · Cited by 12
Self-citationTransparente operative Weiterbildung in der Viszeralchirurgie
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Graduate Medical Education—Accelerated Change
Linville, M. D., & Bates, J. E. (2016) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2016.12.001 · Cited by 10
“The FIRST Trial demonstrated that less restrictive duty hour requirements for surgery residents did not affect patient outcomes and that there was no significant difference in the residents satisfaction or well-being.[4] The authors indicated that having flexible duty hour policies appear to be safe for patients in th…”
Gupta, R., Moore, J. M., Adeeb, N., Griessenauer, C. J., Schneider, A. M., Gandhi, C. D., Harsh, G. R., Thomas, A. J., & Ogilvy, C. S. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.10.022 · Cited by 10
McInnes, C. W., Vorstenbosch, J., Chard, R., Logsetty, S., Buchel, E. W., & Islur, A. (2018) · Plastic Surgery · doi:10.1177/2292550317749512 · Cited by 11
Cardiac Autonomic Modulation during on-Call Duty under Working Hours Restriction
Chien, J., Chen, C. O., Lin, S., Lin, S., & Lin, Y. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17031118 · Cited by 11
Kearse, L. E., Schmiederer, I. S., Dent, D. L., Anderson, T. N., Payne, D. H., Jensen, R. M., Trickey, A. W., Ding, Q., & Korndorffer, J. R. (2022) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000090 · Cited by 10
Overwork among resident physicians: national questionnaire survey results
Ishikawa, M. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03789-7 · Cited by 15
“Comparative reports regarding residents in surgery and internal medicine, using an intervention group without the continuous work time and shift interval restrictions and a control group using the ACGME regulated restrictions, indicated no significant difference in patient outcomes or residents’ degrees of satisfactio…”
Devitt, K. S., Kim, M. J., Conn, L. G., Wright, F. C., Moulton, C.-A. E., Keshet, I., & Ahmed, N. A. (2017) · Academic Medicine · doi:10.1097/acm.0000000000001849 · Cited by 10
Medical Student Perceptions of 24-Hour Call
Skube, S. J., Ramaswamy, A., Chipman, J. G., & Acton, R. D. (2018) · Journal of surgical education · doi:10.1016/j.jsurg.2018.09.002 · Cited by 10
Engels, P. T., Versolatto, A., Shi, Q., et al. (2020) · Canadian Medical Education Journal · doi:10.36834/cmej.69323 · Cited by 10
Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents
Schwartz, L. P., Devine, J. K., Hursh, S. R., Mosher, E., Schumacher, S., Boyle, L., Davis, J. E., Stafford‐Smith, M., & Fitzgibbons, S. (2021) · Journal of surgical education · doi:10.1016/j.jsurg.2021.04.007 · Cited by 8
Saadat, L. V., Dahlke, A. R., Rajaram, R., Kreutzer, L., Love, R. R., Odell, D. D., Bilimoria, K. Y., & Yang, A. D. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.03.026 · Cited by 9
“To study the impact of duty hour reforms on continuity of care and resident education, a prospective, national, cluster-randomized, pragmatic trial, the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, was conducted to examine how increasing flexibility in surgical resident duty hour requirem…”
InfluentialSelf-citationAssociation Between Resident Perceptions of Patient Safety and Duty Hour Violations
Matulewicz, R. S., Odell, D. D., Chung, J. W., Ban, K. A., Yang, A. D., & Bilimoria, K. Y. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.10.044 · Cited by 9
Self-citationWolf, S. J., Akhtar, S. R., Gross, E., Barnes, D., Epter, M. L., Fisher, J., Moreira, M., Smith, M. L., & House, H. R. (2018) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2017.11.35265 · Cited by 9
Multi-institutional Surgical Education Interventions
Salles, A., Milam, L. A., Sevdalis, N., Alseidi, A. A., Mellinger, J. D., Stefanidis, D., Nahmias, J. T., Kulaylat, A. N., Kim, R. H., Falcone, J. L., et al. (2019) · Annals of Surgery · doi:10.1097/sla.0000000000003203 · Cited by 9
“The FIRST trial, which randomly assigned residency programs to the duty hour restrictions of the time versus more flexible duty hour restrictions, is an example of a truly multicentered surgical education intervention related to duty hours, but it was published after the endpoint of the current review.(69) Knowledge a…”
BackgroundSelf-citationPostprocedural Cognitive Load Measurement With Immediate Feedback to Guide Curriculum Development
Huckaby, L. V., Cyr, A. R., Handzel, R. M., Littleton, E. B., Crist, L. R., Luketich, J. D., Lee, K. K. W., & Dhupar, R. (2021) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2021.05.086 · Cited by 9
“In addition, the faculty surgeon completed a resident evaluation for each procedure that rated the resident on (1) understanding the indications for the procedure; (2) proper equipment setup; (3) understanding the anatomy; (4) safe conduct of the procedure; and (5) overall ability to perform the procedure independentl…”
Owei, L., Luks, V. L., Brooks, K. D., Kelz, R. R., Berns, J. S., & Aarons, C. B. (2021) · Journal of surgical education · doi:10.1016/j.jsurg.2021.06.024 · Cited by 11
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“These troubling findings have sparked interest in assessing work-hour restrictions and alternative duty-hour structures as a way to improve trainee well-being without compromising patient care.(7,8) A growing awareness of this issue has also prompted other studies to evaluate strategies for optimizing trainee wellness.”
Impact of medical education on patient safety: finding the signal through the noise
Hwang, J., & Kelz, R. R. (2022) · BMJ Quality & Safety · doi:10.1136/bmjqs-2022-015054 · Cited by 9
Self-citationPatient safety under flexible and standard duty-hour rules
(2019) · New England Journal of Medicine · doi:10.1056/nejmc1905064 · Cited by 8
A 3-Year Study of Resident Reaction to 2011 ACGME Work Hour Rules in a Family Medicine Residency
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The 2016 AANS Presidential Address: Leading the way
Batjer, H. H., & Ban, V. S. (2016) · Journal of neurosurgery · doi:10.3171/2016.7.jns161273 · Cited by 8
Ambulatory Education: Time to Move From Process to Outcome
Warm, E. J., & Mathis, B. R. (2019) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-19-00162.1 · Cited by 8
“Coyle and colleagues point out that large trials such as the iCOMPARE and the FIRST trials were funded because they were framed as patient safety issues, and they suggest using a similar approach to improve ambulatory training.(2,5,6) On the surface this sounds appealing, but we feel this is not pragmatic or likely to…”
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A National Survey of Motor Vehicle Crashes Among General Surgery Residents
Schlick, C. J. R., Hewitt, D. B., Quinn, C. M., Ellis, R. J., Shapiro, K. E., Jones, A. T., Bilimoria, K. Y., & Yang, A. D. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000003729 · Cited by 8
“These items were pretested with general surgery residents using cognitive interviews, and were iteratively reviewed and re-tested before inclusion in the final survey.(14,15) Questions included information on safety-related events after being on call, including nodding off while driving or stopped in traffic, near-mis…”
Self-citationMaintaining Wellness and Instilling Resilience in General Surgeons
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To Leave or to Lie: Duty Hour Restrictions and Patient Ownership
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General surgery residency: Past, present and future
Potts, J. R. (2019) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2019.01.005 · Cited by 7
Doctors’ Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study
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“A randomized control trial comparing standard 16 h shifts with shifts exceeding 16 h, found noninferior patient outcomes and no significant difference in residents’ satisfaction with overall well-being and education quality [19].”
BackgroundBekelis, K., Missios, S., & MacKenzie, T. A. (2017) · Neurosurgery · doi:10.1093/neuros/nyx174 · Cited by 8
Building Surgical Expertise Through the Science of Continuous Learning and Training
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Systematic review of the training process of minimally invasive surgery in neonates and infants
Zahradníková, P., Babala, J., Lindák, M., et al. (2025) · Pediatric Surgery International · doi:10.1007/s00383-025-06095-7 · Cited by 6
“The use of VR has been favored in the surgical education, due to many reasons, such as lack of mentors, reduction in training hours and various issues concerning operative procedures [98].”
General surgery residency: Past, present, and future
Potts, J. R. (2019) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2019.01.006 · Cited by 6
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Metadata
- Authors
- Bilimoria, K. Y., Chung, J. W., Hedges, L. V., Dahlke, A. R., Love, R., Cohen, M. E., Hoyt, D. B., Yang, A. D., Tarpley, J. L., Mellinger, J. D., Mahvi, D. M., Kelz, R. R., Ko, C. Y., Odell, D. D., Stulberg, J. J., & Lewis, F. R.
- Affiliations
- Northwestern University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2016-02-25
- Volume
- 374
- Issue
- 8
- Pages
- 713-727
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2324257729
- Semantic Scholar
- 7619f11ae1a4f21fe37dec8da0c803cc0a2b8ed8
- Cited by
- 460
- References
- 40
- Citations by year
- 2026: 19 · 2025: 30 · 2024: 25 · 2023: 27 · 2022: 31 · 2021: 39 · 2020: 60 · 2019: 70 · 2018: 41 · 2017: 67 · 2016: 50
- FWCI
- 100.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- University of Pennsylvania
- Northwestern University
- Johns Hopkins University
- University of Tennessee at Chattanooga
- Defense Health Agency
- Topics
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Social Sciences › Education › Innovations in Medical Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Keywords
- surgical residency, resident fatigue, postoperative complications, resident well-being, resident education, patient safety, continuity of care, Accreditation Council for Graduate Medical Education, non-inferiority, shift length, resident satisfaction, professionalism, personal activity
- MeSH terms
- Accreditation, Continuity of Patient Care, Education, Medical, Graduate, Fatigue, Hospital Administration, Humans, Internship and Residency, Job Satisfaction, Personnel Staffing and Scheduling, Postoperative Complications, General Surgery, Surgical Procedures, Operative, United States, Work Schedule Tolerance, Workload, Patient Safety
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