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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52 Own result · 16 Own method · 12 Own interpretation · 9 Not checked yet · 6 Sources not found · 3 No full text of the sources
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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In the paper
“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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plainn = 138,691- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 20
- Probably not a substantial claim. 21
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Duty-Hour Flexibility in Surgical Tr aining · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plainn = 138,691- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“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
plain- Asserted: passes — The authors put it forward as true.
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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
“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
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
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
“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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
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).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“Residents were not specifically kept from knowing their studygroup assignment.”
§ National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training > Randomization
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
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
plain- Asserted: fails — The authors may not put it forward as true.
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Probably not a substantial claim. The authors may not put it forward as true.
- Not matched
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
“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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a 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
“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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably 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
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a 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
“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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
“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]
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
“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]
Experimental — accuracy not yet measured
The 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]
Citations
Cites
Piaggio, G., Elbourne, D. R., Pocock, S. J., Evans, S. J. W., Altman, D. G., & CONSORT Group, F. T. (2012) · JAMA · doi:10.1001/jama.2012.87802 · Cited by 2,428
Discrete sequential boundaries for clinical trials
GORDON LAN, K. K., & DEMETS, D. L. (1983) · Biometrika · doi:10.1093/biomet/70.3.659 · Cited by 2,310
Discrete Sequential Boundaries for Clinical Trials
Lan, K. K. G., & DeMets, D. L. (1983) · Biometrika · doi:10.2307/2336502 · Cited by 2,310
Shiloach, M., Frencher, S. K., Steeger, J. E., Rowell, K. S., Bartzokis, K., Tomeh, M. G., Richards, K. E., Ko, C. Y., & Hall, B. L. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2009.09.031 · Cited by 1,306
Self-citationMattar, S. G., Alseidi, A. A., Jones, D. B., Jeyarajah, D. R., Swanstrom, L. L., Aye, R. W., Wexner, S. D., Martinez, J. M., Ross, S. B., Awad, M. M., et al. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e3182a191ca · Cited by 788
Understanding Equivalence and Noninferiority Testing
Walker, E., & Nowacki, A. S. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1513-8 · Cited by 751
Stratified Randomization for Clinical Trials
Kernan, W. N., Viscoli, C. M., Makuch, R. W., Brass, L. M., & Horwitz, R. I. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00138-3 · Cited by 627
Cohen, M. E., Ko, C. Y., Bilimoria, K. Y., Zhou, L., Huffman, K., Wang, X., Liu, Y., Kraemer, K., Meng, X., Merkow, R., et al. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2013.02.027 · Cited by 583
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
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
Discrimination, abuse, harassment, and burnout in surgical residency training
Hu, Y.-Y., Ellis, R. J., Hewitt, D. B., Yang, A. D., Cheung, E. O., Moskowitz, J. T., Potts, J. R., Buyske, J., Hoyt, D. B., Nasca, T. J., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmsa1903759 · Cited by 928
Self-citationGrandner, M. A. (2017) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2016.10.012 · Cited by 720
Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis
Khoushhal, Z., Hussain, M. A., Greco, E., Mamdani, M., Verma, S., Rotstein, O., Tricco, A. C., & Al-Omran, M. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2016.4086 · Cited by 281
Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors
Trockel, M., Menon, N. K., Rowe, S. G., Stewart, M. T., Smith, R. H., Lu, M., Kim, P. K., Quinn, M. A., Lawrence, E., Marchalik, D., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.28111 · Cited by 269
Aziz, H., James, T., Remulla, D., Sher, L., Genyk, Y., Sullivan, M. E., & Sheikh, M. R. (2021) · Journal of Surgical Education · doi:10.1016/j.jsurg.2020.07.037 · Cited by 229
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.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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