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
Nasca, T. J., Day, S. H., & Amis, E. S. (2010) · New England Journal of Medicine · doi:10.1056/nejmsb1005800 · Cited by 556
New Requirements for Resident Duty Hours
Philibert, I. (2002) · JAMA · doi:10.1001/jama.288.9.1112 · Cited by 531
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 201–300 of 459
Divides of identity in medicine and surgery: A review of duty-hour policy preference
Brenna, C. T. A., & Das, S. (2020) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2020.07.006 · Cited by 6
“The FIRST Trial performed an analogous, national cluster-randomized study of duty-hour flexibility in general surgery residency programs in the US [23].”
BackgroundMethodInfluentialKelly-Schuette, K. A., Shaker, T. M., Carroll, J., Davis, A. T., Wright, G. P., & Chung, M. H. (2020) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-20-00304.1 · Cited by 6
“However, residents with flexible duty hour policies perceived negative effect on time with family, rest, and health.(3) Variation in call schedules are still used to accommodate duty hour restrictions and improve resident sleep.”
Leafloor, C. W., Liu, E. Y., Code, C., Lochnan, H. A., Keely, E., Rothwell, D. M., Forster, A. J., & Huang, A. R. (2017) · Canadian Medical Education Journal · doi:10.36834/cmej.36948 · Cited by 6
Using an anonymous, resident-run reporting mechanism to track self-reported duty hours
Zamani, N., Fallon, S. C., Bremer, A., Silberfein, E. J., Rosengart, T. K., & Scott, B. G. (2019) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2018.12.065 · Cited by 6
Burning the candle at both ends: Mitigating surgeon burnout at the training stages
Swain, J. D., Ballester, J. M. S., Luc, J. G. Y., & Han, J. J. (2020) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2020.06.122 · Cited by 6
Infinite cornucopia: The future of education and training in oral and maxillofacial surgery
Bell, R. B. (2016) · Oral Surgery Oral Medicine Oral Pathology and Oral Radiology · doi:10.1016/j.oooo.2016.02.010 · Cited by 6
The impact of shortening shifts of physicians during their residency on patients and physicians
Daitch, V., Poran, I., & Leibovici, L. (2025) · Israel Journal of Health Policy Research · doi:10.1186/s13584-025-00715-2 · Cited by 6
“Among these, five studies [48, 61–64] (including two RCTs) [48, 61] found no association between shift shortening and complications, while two studies reported worsened complication rates after the implementation of ACGME 2003-DHR [66, 67].”
Blay, E., Engelhardt, K. E., Hewitt, D. B., Dahlke, A. R., Yang, A. D., & Bilimoria, K. Y. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2018.1047 · Cited by 5
Self-citationCurrent status and directions of resident education
Jung, S. (2019) · Journal of Korean Medical Association · doi:10.5124/jkma.2019.62.2.72 · Cited by 5
Public opinion of resident physician work hours in 2022
Weaver, M. D., Barger, L. K., Sullivan, J. P., Quan, S. F., Robbins, R., Landrigan, C. P., & Czeisler, C. A. (2023) · Sleep Health · doi:10.1016/j.sleh.2023.08.016 · Cited by 6
Why Residencies Should Fly: Towards a Logical Approach to Duty Hour Reform
Luciano, G. L., Hambour, L., Luciano, P., Holmboe, E. S., Aulakh, S. K., Fleming, S. S., & Rosenblum, M. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-05894-z · Cited by 4
“The FIRST trial, conducted in surgical residencies, found no differences in patient outcomes or resident well-being.(3) Initial results from iCompare, evaluating internal medicine residents, demonstrated no significant differences between how residents spent clinical and educational time.”
BackgroundResultTemplate for a program tailored ACS/APDS phase 1 curriculum: From needs assessment to implementation
Purnell, S. M., Bass, B. L., Benavides, B., et al. (2021) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2021.03.034 · Cited by 5
Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
Salgado, S. M., Katz, J. T., Pelletier, S. R., Goodberlet, M., Kelly, J., Duperreault, M., Ali, N. B., & Shields, H. M. (2022) · Journal of Patient Safety · doi:10.1097/pts.0000000000000988 · Cited by 8
Not the Last Word: Two Patients, Two Operating Rooms, One Surgeon—Does The Math Add Up?
Bernstein, J. M. (2016) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-016-5001-2 · Cited by 5
“To my knowledge, there has been only one review of simultaneous surgery’s effect on outcome [5].”
Bilimoria, K. Y., Hoyt, D. B., & Lewis, F. R. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.2218 · Cited by 5
Self-citationThe Urology Residency Program in Israel—Results of a Residents Survey and Insights for the Future
Lavi, A., Tzemah, S., Hussein, A., et al. (2017) · Rambam Maimonides Medical Journal · doi:10.5041/rmmj.10317 · Cited by 5
Self-citationA Roadmap for Research on Resident Well-Being
Quinn, M. A., Bazari, H., Ripp, J., Block, L., Chretien, K. C., Fried, E. D., Leiter, R. E., Pincavage, A. T., Spataro, B. M., Trockel, M., et al. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.12.001 · Cited by 5
Transitions in surgical education
Meyers, M. O., & Charles, A. G. (2019) · Surgery · doi:10.1016/j.surg.2019.08.024 · Cited by 5
In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs
Maratta, C., Hutchison, K., Moore, G. P., Bagshaw, S. M., Granton, J. T., Kirpalani, H. M., Stelfox, H. T., Ferguson, N. D., Cook, D., & Parshuram, C. S. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004598 · Cited by 5
“The current evidence—mainly from randomized control trials (RCTs) in the United States—have not demonstrated benefits or harms from modification of duty hours in general surgical and internal medicine programs (24, 25).”
BackgroundContextualizing the Resurgence of U.S. Housestaff Union Activity
Lin, G. L., Priest, K. C., Sossenheimer, P. H., & Pal, R. (2024) · Academic Medicine · doi:10.1097/acm.0000000000005816 · Cited by 5
Stulberg, J. J., Pavey, E. S., Cohen, M. E., Ko, C. Y., Hoyt, D. B., & Bilimoria, K. Y. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.10.040 · Cited by 5
Self-citationGerjevic, K. A., Rosenbaum, M., & Suneja, M. (2017) · BMC Medical Education · doi:10.1186/s12909-017-0963-7 · Cited by 5
Bennett, C., McDonald, D. A., Dorner, S. C., Nadel, E. S., McDonald, F. S., & McPherson, J. (2017) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-17-00547.1 · Cited by 5
“Both reforms stemmed from a growing concern about the effects of resident fatigue on both patient safety and resident well-being.(1,2) There has been much debate surrounding these reforms, and opponents have argued that they have negatively affected resident education.”
InfluentialWellness in Residency: A Paradigm Shift
Quiros, R. M., & Black, E. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.82343 · Cited by 6
“The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial involved 117 American general surgical residency programs and was conducted to test whether surgical patient outcomes under flexible, less-restrictive duty hour policies would be non-inferior to those under standard ACGME policies [29].”
Variability in Institutional Board Review for a Multisite Assessment of Resident Professionalism
Linden, J. A., Schneider, J. I., Cotter, A., Drexel, S., Frosch, E. J., Martin, N. D., Canavan, C., Holtman, M. C., Mitchell, P. M., & Feldman, J. A. (2019) · Journal of Empirical Research on Human Research Ethics · doi:10.1177/1556264619831895 · Cited by 5
Beyond duty hours: leveraging large-scale paging data to monitor resident workload
Kaushal, A., Katznelson, L. J., & Harrington, R. A. (2019) · npj Digital Medicine · doi:10.1038/s41746-019-0165-2 · Cited by 5
Zhuo, Y., Cheng, X., Fang, H., et al. (2022) · Biomaterials Science · doi:10.1039/d1bm01212f · Cited by 5
iCOMPARE: An Intern's Perspective
Alvin, M. D. (2017) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-16-00711.1 · Cited by 5
Failing Safely: Autonomy and Identity Formation in Medical Training
Rink, D. E., Berger, G. N., & Albert, T. J. (2025) · ATS Scholar · doi:10.34197/ats-scholar.2024-0081vl · Cited by 4
“Although challenging to study in their totality, data on the effect of these changes on resident training are mixed; some support work-hour regulations as being positive for trainee well-being, yet none have established clear differences in clinical or educational outcomes (5 – 10).”
Is the Institutionalization of Wellness the Answer to Trainee Burnout?
Cole, A. G. (2018) · American Journal of Psychiatry Residents Journal · doi:10.1176/appi.ajp-rj.2018.130706 · Cited by 4
“Designed to reduce trainee fatigue and improve patient safety, duty hour restrictions have been found to, by and large, succeed in neither, as demonstrated in large longitudinal studies (6).”
The House of God at Age 40—An Appreciation
Faust, J. S. (2019) · JAMA · doi:10.1001/jama.2019.8156 · Cited by 4
Camargo, C. P., Damous, S. H. B., Miranda, J. D. S., et al. (2025) · Clinics · doi:10.1016/j.clinsp.2025.100609 · Cited by 4
Smartphone Application as an Education Platform in Hepato-Pancreato-Biliary Surgery
Roy, M., Dip, F., Rosales, A., Roche, M., & Hutchins, R. (2019) · Surgical Innovation · doi:10.1177/1553350619848210 · Cited by 4
Dine, C. J., Liu, M., Asch, D. A., et al. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05334-7 · Cited by 4
Self-citationNadaleto, B. F., & Herbella, F. A. M. (2021) · AME Surgical Journal · doi:10.21037/asj-21-24 · Cited by 3
Costa, G., Tommasi, E., Giovannini, L., & Mucci, N. (2020) · Springer eBooks · doi:10.1007/978-3-030-59403-9_29 · Cited by 7
Chi, D., Chen, A. D., Wu, W. W., Chattha, A. S., Lee, B. T., & Lin, S. J. (2023) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000004820 · Cited by 4
Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions
Reeves, J. J., Goldhaber, N. H., Hollandsworth, H. M., Cox, K. E., Dumitru, A. M., Zhao, B., Longhurst, C., Berumen, J. A., Berndtson, A. E., Jacobsen, G. R., et al. (2024) · JAMA Surgery · doi:10.1001/jamasurg.2024.5518 · Cited by 5
2011 ACGME Duty Hour Limits had No Association With Breast Reconstruction Complications
Simpson, A. M., Kwok, A. C., Collier, W., Kim, J., Veith, J., & Agarwal, J. P. (2019) · Journal of Surgical Research · doi:10.1016/j.jss.2019.09.058 · Cited by 4
Deriving Evidence from Secondary Data in Hand Surgery
Squitieri, L. S., & Chung, K. C. (2020) · Hand Clinics · doi:10.1016/j.hcl.2020.01.011 · Cited by 4
Chung, J. W., Bilimoria, K. Y., Stulberg, J. J., Quinn, C. M., & Hedges, L. V. (2017) · Health Services Research · doi:10.1111/1475-6773.12752 · Cited by 4
Self-citationHorn, A. R., Weijer, C., Hey, S. P., Brehaut, J., Fergusson, D. A., Goldstein, C. E., Grimshaw, J., & Taljaard, M. (2018) · Journal of Medical Ethics · doi:10.1136/medethics-2017-104282 · Cited by 4
A Critical Appraisal of the July Effect: Evaluating Complications Following Pancreaticoduodenectomy
Murtha, T. D., Kunstman, J. W., Healy, J. M., et al. (2019) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-019-04357-z · Cited by 4
Manzoor, F., Sundrelingam, V., Roberts, S. B., Fralick, M., Kwan, J. L., Tang, T., Weinerman, A. S., Rawal, S., Liu, J. J., Redelmeier, D. A., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.4516 · Cited by 3
One is too many: suicidality among general surgery residents
Nasca, B. J., Hunt, M., Ramirez, R. T., Eng, J. S., Li, R. D., Agarwal, G., Bilimoria, K. Y., & Hu, Y. (2025) · Academic Medicine · doi:10.1093/acamed/wvaf105 · Cited by 3
Self-citationResidency Training: The Review Committee for Neurology
Nevel, K. S., Southerland, A. M., Kilgore, S. M., & Gutmann, L. (2017) · Neurology · doi:10.1212/wnl.0000000000004766 · Cited by 3
“a Flexibility in duty hour requirements for surgical trainees, data from 2014 to 2015 academic year, results from 2015 to 2017 pending.(8) b Individualized comparative effectiveness of models optimizing patient outcome and resident education, enrollment began 2015, with results pending.”
Sleep and Wellness in Residency—Embracing the Shift
Prasad, B., & Arora, V. M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.38294 · Cited by 3
Weaver, M. D., Barger, L. K., Sullivan, J. P., Qadri, S., Czeisler, C. A., & Landrigan, C. P. (2025) · The American Journal of Medicine · doi:10.1016/j.amjmed.2025.01.001 · Cited by 3
Hewitt, D. B., Patel, H. J., Lee, S.-H., Lowe, C., Shields, M. C., Liu, M., Pieper, H., & Meara, M. P. (2025) · Surgical Endoscopy · doi:10.1007/s00464-024-11513-3 · Cited by 3
“Multiple factors contribute to these perceptions, including duty hour restrictions, decreasing autonomy during cases, increased complexity of surgical technique, and the need to master multiple surgical approaches: open, laparoscopic, robotic, and endoscopic [8–11].”
Scholarly Conversations in Medical Education
OʼBrien, B. C., May, W., & Horsley, T. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001378 · Cited by 3
Factors associated with overwork among pediatricians at Japanese hospitals
Ishikawa, M. (2022) · Pediatrics International · doi:10.1111/ped.15173 · Cited by 3
Chen, H.-H. A. (2019) · PEDIATRICS · doi:10.1542/peds.2019-1210 · Cited by 88
Ni, S., Yu, Q., Zhong, Z., et al. (2022) · Journal of Biopharmaceutical Statistics · doi:10.1080/10543406.2022.2065502 · Cited by 3
Perceptions of Fatigue and Safety Climate Pertaining to Residency Duty-Hour Restrictions
Carr, M. M., Friedel, J. E., O’Brien, D. C., et al. (2022) · Cureus · doi:10.7759/cureus.28929 · Cited by 3
“or a group using a flexible policy that waived rules on maximum shift lengths and time off between shifts [22].”
BackgroundResultExtended work hours increase risk of harm, regardless of resident physicians’ experience levels
Czeisler, C. A., Weaver, M. D., Landrigan, C. P., & Barger, L. K. (2023) · BMJ · doi:10.1136/bmj.p838 · Cited by 4
Mouawad, N. J., Kulaylat, A. N., & Hoffman, R. L. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.2215 · Cited by 3
Duty Hour Restrictions, Revisited: Second Year of FIRST Trial
Kolcun, J. P. G., Madhavan, K., & Wang, M. Y. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.08.114 · Cited by 3
Duty-Hour Flexibility Trial in Internal Medicine
Asch, D. A., Shea, J. A., & Desai, S. V. (2018) · New England Journal of Medicine · doi:10.1056/nejmc1806648 · Cited by 3
RESPONSE: Cardiovascular Education Scholars
Dauerman, H. L. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.032 · Cited by 3
Miyahara, J., Ohya, J., Kawamura, N., Ohtomo, N., & Kunogi, J. (2020) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2020.09.019 · Cited by 3
Association for Academic Surgery presidential address: the rookie advantage
Dimick, J. B. (2016) · Journal of Surgical Research · doi:10.1016/j.jss.2016.03.024 · Cited by 3
Choi, Y., Kim, D. H. S., Chong, H., et al. (2017) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-16-00211.1 · Cited by 3
The Association for Academic Surgery 2011-present: standing on the shoulders of giants
Speer, A. L., & Kao, L. S. (2017) · Journal of Surgical Research · doi:10.1016/j.jss.2017.06.013 · Cited by 3
Coverdill, J. E., Alseidi, A. A., Borgstrom, D. C., Dent, D. L., Dumire, R. D., Fryer, J. P., Hartranft, T. H., Holsten, S. B., Nelson, M. T., Shabahang, M. M., et al. (2017) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2017.08.053 · Cited by 4
Self-citationRiall, T. S. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000002779 · Cited by 3
“In addition, there was an interaction between sex, PGY, and duty hour assignment arm in the FIRST trial.(4) There were no sex-based differences in perceptions of residency training among interns, but as they progressed through their residency, women were more likely than men to be dissatisfied with patient safety, hea…”
MethodEyes Wide Open — Examining the Data on Duty-Hour Reform
Rosenbaum, L. R., & Lamas, D. J. (2019) · New England Journal of Medicine · doi:10.1056/nejme1817497 · Cited by 3
Mastery Learning of Surgical Skills
Teitelbaum, E. N., Barsness, K. A., & Hungness, E. S. (2020) · Comprehensive healthcare simulation · doi:10.1007/978-3-030-34811-3_12 · Cited by 5
Domínguez, L. C., Vega, N. V., & Sanabria, Á. (2024) · Revista Colombiana de Cirugía · doi:10.30944/20117582.2569 · Cited by 2
Kilcullen, M., Zhang, A., Sharma, R., Xiao, C., Bass, E. B., & Rosen, M. A. (2025) · Journal of Patient Safety and Risk Management · doi:10.1177/25160435251342308 · Cited by 2
Ishikawa, M., Seto, R., Oguro, M., & Sato, Y. (2025) · Healthcare · doi:10.3390/healthcare13151815 · Cited by 3
“In the United States, the ACGME has implemented working hour restrictions for residents, with reports indicating no significant differences in patient outcomes or resident satisfaction compared with non-restricted groups [14,15].”
Basios, A., Voloudakis, N., Atmatzidis, S. K., et al. (2025) · Updates in Surgery · doi:10.1007/s13304-025-02387-8 · Cited by 2
“According to the FIRST trial published in 2016, surgical residents have flexible working programs [23].”
Lark, M. E., Airhart, A. E., Miller, P. M., Chung, J. W., & Bilimoria, K. Y. (2025) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-25-00784.1 · Cited by 3
Self-citationDoes it matter how much physician trainees work anymore?
Fletcher, K. E., & Ranji, S. R. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2016-005534 · Cited by 2
Hoops, H. E., Maynard, E. C., & Brasel, K. J. (2017) · Current Surgery Reports · doi:10.1007/s40137-017-0195-0 · Cited by 2
Berry, A. C., & McClain, E. K. (2018) · Journal of Osteopathic Medicine · doi:10.7556/jaoa.2018.116 · Cited by 2
The Policy Life Cycle—Evaluating Health Policies With Diminishing Returns
Chhabra, K. R., Ryan, A. M., & Dimick, J. B. (2020) · JAMA Health Forum · doi:10.1001/jamahealthforum.2020.0294 · Cited by 2
Huber, J. N., Olgun, G., Whalen, L. D., Sandeen, A., Rana, D. T., & Zenel, J. A. (2020) · Medical Science Educator · doi:10.1007/s40670-020-01036-6 · Cited by 2
State of well-being among residents in a tertiary center in Riyadh, Saudi Arabia
AlAhmari, F. S., Al-Oqail, A., Almansour, S., & Bagha, M. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04596-4 · Cited by 2
“Similarly, a previous study found that residents of flexible duty-hour systems noted various advantages in regard to near all aspects of patient safety, quality of treatment, surgical training, and professionalism [25].”
Exploring sleep duration and clinical reasoning process in resident physicians: a thematic analysis
Collen, J. F., Durning, S. J., Berk, J., Mang, J., Alcover, K. C., & Jung, E. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11134 · Cited by 2
“29 Subsequent studies, also published in the New England Journal of Medicine , looked at internal medicine residencies, failing to find an impact of work hours on patient outcomes, quality of life, or education.”
PENGGUNAAN VIRTUAL REALITY DAN AUGMENTED REALITY DALAM PENDIDIKAN KEDOKTERAN
Agastya, I. G. E. A. A. (2024) · National Conference on Applied Business Education & Technology (NCABET) · doi:10.46306/ncabet.v3i1.171 · Cited by 2
“(Bilimoria, 2016) Untuk membantu dari permasalahan diatas beberapa Solusi sudah diimplementasikan seperti da Vinci Skills Simulator dan LAP mentor VR Laparoscopic surgical simulator.”
Vogt-Yerem, R. L., Heck, P. R., Mestechkin, R. M., Heydari, P., Chabris, C. F., & Meyer, M. N. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-084699 · Cited by 3
Rada‐Estarita, A. A., Rincón‐Ortiz, M. C., Rodríguez, O. G. H., & Olmos‐Vega, F. M. (2024) · Medical Education · doi:10.1111/medu.15557 · Cited by 2
Alter, I. L., Kutler, R. B., Cai, Y., et al. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11502 · Cited by 2
Ishikawa, M., Seto, R., Oguro, M., & Sato, Y. (2025) · Environmental and Occupational Health Practice · doi:10.1539/eohp.2024-0018 · Cited by 2
“For instance, studies comparing intervention groups of surgery and internal medicine residents without restrictions on continuous work hours or rest intervals with control groups with ACGME-imposed restrictions reported no significant differences in patient outcomes or resident satisfaction 21,22) .”
Goettler, C. E. (2020) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-19-00706.1 · Cited by 2
Chang, P.-Y., Kolcun, J. P. G., & Wang, M. Y. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.05.090 · Cited by 2
Ferraris, V. A. (2016) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2016.09.091 · Cited by 2
Zuckerman, S. L., Morone, P. J., & Dewan, M. C. (2017) · Neurosurgery · doi:10.1093/neuros/nyx132 · Cited by 2
The role of multiorgan procurement for abdominal transplant in general surgery resident education
Bayer, J., Moulton, C.-A., Monden, K. R., et al. (2017) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2017.08.015 · Cited by 2
An Appeal for Evidence-Based Resident Duty Hours Reform
Khoong, E. C., & Linker, A. S. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.4469 · Cited by 2
Cillo, J. E., Aghaloo, T. L., Basi, D. L., Bouloux, G. F., Campbell, J. A., Chou, J. C., Dodson, T. B., Edwards, S. P., Kademani, D., & Peacock, Z. S. (2017) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2017.10.018 · Cited by 2
Quality Improvement and Patient Safety
Ferguson, E. L., & Sundaram, C. P. (2017) · Springer eBooks · doi:10.1007/978-3-319-64728-9_19 · Cited by 2
The Media Response to the ACGME’s 2017 Relaxed Resident Duty-Hour Restrictions
Zhang, Z. M., Krauthamer, A. V., & Rosenkrantz, A. B. (2017) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2017.10.026 · Cited by 2
Making It Stick: Keys to Effective Feedback and Debriefing in Surgical Education
Paige, J. T. (2019) · Comprehensive healthcare simulation · doi:10.1007/978-3-319-98276-2_12 · Cited by 2
In reference to Otolaryngology workforce analysis
Anne, S., & Chandrasekhar, S. S. (2017) · The Laryngoscope · doi:10.1002/lary.26502 · Cited by 2
“However, there are many other articles that would suggest that decreased work hours do not affect training experience, and in addition improve resident morale and patient outcomes.(4,5) The fact is that there is no consistency in data that is available and presenting one-sided data to support an argument are misleadin…”
Kelly-Schuette, K. A., Osantowski, B. C., Chung, M. H., & Wright, G. P. (2020) · Journal of surgical education · doi:10.1016/j.jsurg.2020.02.007 · Cited by 2
Sleep quality during an overnight on-call program
Cannon, L., Ali, D., Parli, S. E., Martin, C. A., & Cook, A. M. (2020) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxaa113 · Cited by 2
American Surgical Association Presidential Forum
Lillemoe, K. D., Klingensmith, M. E., Darzi, A. W., & Taylor, S. M. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002433 · Cited by 2
“Additionally, the ABS was 1 of several groups that funded the FIRST duty-hour trial which resulted in recent modifications to the ACGME duty hours; these changes greater focus on a learner-dependent rather than educator-dependent environment.(37,38) Finally, the ABS has helped to fund a study on the use of hand-held d…”
Medicine’s dangerous optimism: lessons from Dr Pangloss
Mazer, B. L. (2020) · Journal of the Royal Society of Medicine · doi:10.1177/0141076820907061 · Cited by 2
“To address the duty-hour question, two trials have recently been performed on surgery and internal medicine residents.(8,9) The trials were designed as ‘non-inferiority’ studies, a low bar in which longer shifts need only show not substantially worse patient mortality than shorter shifts.”
MethodAre Esophagectomy Board Requirements Achievable? A Multi-Institutional Analysis
Luc, J. G. Y., Reddy, R. M., Corsini, E. M., et al. (2021) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2021.02.025 · Cited by 2
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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