Duty Hour Recommendations and Implications for Meeting the ACGME Core Competencies: Views of Residency Directors
Open accessAbstract
Objective To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education.Methods US residency program directors in internal medicine, pediatrics, and general surgery were e-mailed a survey from July 8 through July 20, 2010, after the 2010 Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations were published. Directors were asked to rate the implications of the new recommendations for the 6 ACGME core competencies as well as for continuity of inpatient care and resident fatigue.Results Of 719 eligible program directors, 464 (65%) responded. Most program directors believe that the new ACGME recommendations will decrease residents' continuity with hospitalized patients (404/464 [87%]) and will not change (303/464 [65%]) or will increase (26/464 [6%]) resident fatigue. Additionally, most program directors (249-363/464 [53%-78%]) believe that the new duty hour restrictions will decrease residents' ability to develop competency in 5 of the 6 core areas. Surgery directors were more likely than internal medicine directors to believe that the ACGME recommendations will decrease residents' competency in patient care (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5-6.3), medical knowledge (OR, 1.9; 95% CI, 1.2-3.2), practice-based learning and improvement (OR, 2.7; 95% CI, 1.7-4.4), interpersonal and communication skills (OR, 1.9; 95% CI, 1.2-3.0), and professionalism (OR, 2.5; 95% CI, 1.5-4.0).Conclusion Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Association of resident fatigue and distress with perceived medical errors
West, C. P. (2009) · JAMA · doi:10.1001/jama.2009.1389 · Cited by 999 · see citing works
Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures
Lockley, S. W., Cronin, J. W., Evans, E. E., Cade, B. E., Lee, C. J., Landrigan, C. P., Rothschild, J. M., Katz, J. T., Lilly, C. M., Stone, P. H., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa041404 · Cited by 913 · see citing works
The 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 · see citing works
New Requirements for Resident Duty Hours
Philibert, I. (2002) · JAMA · doi:10.1001/jama.288.9.1112 · Cited by 531 · see citing works
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety
Ulmer, C. C., Wolman, D. M., & Johns, M. M. E. (2009) · Cited by 481 · see citing works
Asch, D. A., & Parker, R. M. (1988) · New England Journal of Medicine · doi:10.1056/nejm198803243181209 · Cited by 398 · see citing works
The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons
Hutter, M. M., Kellogg, K. C., Ferguson, C. M., Abbott, W. M., & Warshaw, A. L. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000220042.48310.66 · Cited by 397 · see citing works
Lurie, S. J., Mooney, C. J., & Lyness, J. M. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181971f08 · Cited by 365 · see citing works
A review of studies concerning effects of sleep deprivation and fatigue on residentsʼ performance
Samkoff, J. S., & Jacques, C. H. (1991) · Academic Medicine · doi:10.1097/00001888-199111000-00013 · Cited by 342 · see citing works
Burnout and Internal Medicine Resident Work-Hour Restrictions
Gopal, R., Glasheen, J. J., Miyoshi, T. J., & Prochazka, A. V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.22.2595 · Cited by 333 · see citing works
Effects of Work Hour Reduction on Residents’ Lives: A Systematic Review
Fletcher, K. E., Underwood, W., Davis, S. Q., Mangrulkar, R. S., McMahon, L. F., & Saint, S. (2005) · JAMA · doi:10.1001/jama.294.9.1088 · Cited by 328 · see citing works
Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Even-Shoshan, O., Wang, Y., Bellini, L., Behringer, T., & Silber, J. H. (2007) · JAMA · doi:10.1001/jama.298.9.975 · Cited by 325 · see citing works
Effects of Limited Work Hours on Surgical Training
Barden, C. B., Specht, M. C., McCarter, M. D., Daly, J. M., & Fahey, T. J. (2002) · Journal of the American College of Surgeons · doi:10.1016/s1072-7515(02)01242-5 · Cited by 292 · see citing works
Transfers of Patient Care Between House Staff on Internal Medicine Wards: A National Survey
Horwitz, L. I., Krumholz, H. M., Green, M. L., & Huot, S. J. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.11.1173 · Cited by 286 · see citing works
Kairys, J. C., McGuire, K. P., Crawford, A. G., & Yeo, C. J. (2008) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.12.055 · Cited by 246 · see citing works
Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Even-Shoshan, O., Canamucio, A., Bellini, L., Behringer, T., & Silber, J. H. (2007) · JAMA · doi:10.1001/jama.298.9.984 · Cited by 228 · see citing works
Volpp, K. G. M., Rosen, A. K., & Rosenbaum, P. R. (2008) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2007.11.035 · Cited by 223 · see citing works
Systematic Review: Effects of Resident Work Hours on Patient Safety
Fletcher, K. E., Davis, S. Q., Underwood, W., Mangrulkar, R. S., McMahon, L. F., & Saint, S. K. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-11-200412070-00009 · Cited by 222 · see citing works
Landrigan, C. P., Fahrenkopf, A. M., Lewin, D. S., Sharek, P. J., Barger, L. K., Eisner, M., Edwards, S., Chiang, V. W., Wiedermann, B. L., & Sectish, T. C. (2008) · PEDIATRICS · doi:10.1542/peds.2007-2306 · Cited by 190 · see citing works
The Debate over Residents' Work Hours
Steinbrook, R. (2002) · New England Journal of Medicine · doi:10.1056/nejmhpr022383 · Cited by 187 · see citing works
Changes in Hospital Mortality Associated with Residency Work-Hour Regulations
Shetty, K. D., & Bhattacharya, J. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-2-200707170-00161 · Cited by 170 · see citing works
Effect of the 80-hour work week on resident operative experience in general surgery
Carlin, A. M., Gasevic, E., & Shepard, A. D. (2007) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2006.09.014 · Cited by 163 · see citing works
Meta-Analysis of the Relationship Between Total Sleep Deprivation and Performance
Koslowsky, M., & Babkoff, H. (1992) · Chronobiology International · doi:10.3109/07420529209064524 · Cited by 158 · see citing works
The Effects of On-Duty Napping on Intern Sleep Time and Fatigue
Arora, V. M., Dunphy, C., Chang, V. Y., Ahmad, F., Humphrey, H. J., & Meltzer, D. O. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-11-200606060-00005 · Cited by 144 · see citing works
Damadi, A., Davis, A. T., Saxe, A., & Apelgren, K. N. (2007) · Journal of surgical education · doi:10.1016/j.jsurg.2007.07.008 · Cited by 141 · see citing works
Cost Implications of Reduced Work Hours and Workloads for Resident Physicians
Nuckols, T. K., Bhattacharya, J., Wolman, D. M., Ulmer, C. C., & Escarce, J. J. (2009) · New England Journal of Medicine · doi:10.1056/nejmsa0810251 · Cited by 131 · see citing works
Martini, S., Arfken, C. L., & Balon, R. (2006) · Academic Psychiatry · doi:10.1176/appi.ap.30.4.352 · Cited by 126 · see citing works
Cohen‐Gadol, A., Piepgras, D. G., Krishnamurthy, S., & Fessler, R. D. (2005) · Neurosurgery · doi:10.1227/01.neu.0000147999.64356.57 · Cited by 116 · see citing works
Richardson, G. S., Wyatt, J. K., Sullivan, J. P., Orav, E. J., Ward, A. E., Wolf, M. A., & Czeisler, C. A. (1996) · SLEEP · doi:10.1093/sleep/19.9.718 · Cited by 95 · see citing works
Effect of Duty Hour Standards on Burnout among Orthopaedic Surgery Residents
Barrack, R. L., Miller, L. S., Sotile, W. M., Sotile, M. O., & Rubash, H. E. (2006) · Clinical Orthopaedics and Related Research · doi:10.1097/01.blo.0000224030.78108.58 · Cited by 88 · see citing works
An Elusive Balance — Residents' Work Hours and the Continuity of Care
Okie, S. (2007) · New England Journal of Medicine · doi:10.1056/nejmp078085 · Cited by 84 · see citing works
ACGME Duty-Hour Recommendations — A National Survey of Residency Program Directors
Antiel, R. M., Thompson, S. M., Reed, D. A., James, K. M., Tilburt, J. C., Bannon, M. P., Fischer, P. R., & Farley, D. R. (2010) · New England Journal of Medicine · doi:10.1056/nejmp1008305 · Cited by 84 · see citing works
Self-citationRosen, A. K., Loveland, S. A., Romano, P. S., Itani, K. M. F., Silber, J. H., Even-Shoshan, O. O., Halenar, M. J., Teng, Y., Zhu, J., & Volpp, K. G. (2009) · Medical Care · doi:10.1097/mlr.0b013e31819a588f · Cited by 81 · see citing works
Kort, K. C., Pavone, L. A., Jensen, E. H., Haque, E., Newman, N. B., & Kittur, D. S. (2004) · Surgery · doi:10.1016/j.surg.2004.07.005 · Cited by 72 · see citing works
Goldstein, M. J., Kim, E. S., Widmann, W. D., & Hardy, M. A. (2004) · Current Surgery · doi:10.1016/j.cursur.2004.03.013 · Cited by 66 · see citing works
Sleep deprivation and house staff performance. Update 1984-1991.
Leung, L., & Becker, C. (1992) · PubMed · Cited by 59 · see citing works
Impact of Duty Hours Restrictions on Quality of Care and Clinical Outcomes
Bhavsar, J., Montgomery, D., Li, J., Kline-Rogers, E. M., Saab, F. A., Motivala, A. A., Froehlich, J. B., Parekh, V. I., Valle, J. D., & Eagle, K. A. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.07.026 · Cited by 57 · see citing works
Perspective: The ACGME Toolbox: Half Empty or Half Full?
Green, M. L., & Holmboe, E. S. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181d737a6 · Cited by 56 · see citing works
Basu, C. B., Chen, L.-M., Hollier, L. H., & Shenaq, S. M. (2004) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000142768.07468.64 · Cited by 52 · see citing works
Prasad, M., Iwashyna, T. J., Christie, J. D., Kramer, A. A., Silber, J. H., Volpp, K. G. M., & Kahn, J. M. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181a93468 · Cited by 49 · see citing works
Residents?? Perceptions of the Effects of Work Hour Limitations at a Large Teaching Hospital
Lin, G. A., Beck, D. C., & Garbutt, J. M. (2006) · Academic Medicine · doi:10.1097/00001888-200601000-00017 · Cited by 47 · see citing works
Impact of the Libby Zion case on graduate medical education in internal medicine.
Brensilver, J. M., Smith, L., & Lyttle, C. S. (1998) · PubMed · Cited by 46 · see citing works
The effect of resident work hour regulations on orthopaedic surgical education.
Weatherby, B. A., Rudd, J. N., Ervin, T., Stafford, P. R., & Norris, B. L. (2007) · PubMed · Cited by 44 · see citing works
Residents' perceptions of a night float system
Jasti, H., Hanusa, B. H., Switzer, G. E., Granieri, R., & Elnicki, M. (2009) · BMC Medical Education · doi:10.1186/1472-6920-9-52 · Cited by 41 · see citing works
Sharpening the Focus on Systems-Based Practice
Batalden, P. B., & Leach, D. C. (2009) · Journal of Graduate Medical Education · doi:10.4300/01.01.0001 · Cited by 28 · see citing works
Building Physician Work Hour Regulations From First Principles and Best Evidence
Volpp, K. G. M. (2008) · JAMA · doi:10.1001/jama.300.10.1197 · Cited by 28 · see citing works
Residents' Duty Hours and Professionalism
Rybock, J. D. (2009) · New England Journal of Medicine · doi:10.1056/nejmc0905152 · Cited by 25 · see citing works
Lieberman, J. D., Olenwine, J. A., Finley, W., & Nicholas, G. G. (2005) · Current Surgery · doi:10.1016/j.cursur.2004.06.015 · Cited by 23 · see citing works
New Recommendations on Duty Hours from the ACGME
Albert, R. K., & Wiener, C. M. (2010) · New England Journal of Medicine · doi:10.1056/nejmc1008813 · Cited by 20 · see citing works
Changes in Residentsʼ Attitudes in Response to Residency Program Modifications: A Prospective Study
Seelig, C. B. (1992) · Southern Medical Journal · doi:10.1097/00007611-199210000-00010 · Cited by 18 · see citing works
Rosenberg, M., & McNulty, D. (1995) · Journal of General Internal Medicine · doi:10.1007/bf02600236 · Cited by 15 · see citing works
The impact of the new code regulations on postgraduate medical education in New York State.
Sc, R. (1989) · PubMed · Cited by 14 · see citing works
Limiting Residents' Work Hours
Potee, R. A. (2002) · JAMA · doi:10.1001/jama.288.23.2973-jlt1218-6-1 · Cited by 2 · see citing works
Auger, K. A., Sieplinga, K. R., Simmons, J. M., & del Rey, J. A. G. (2010) · Academic Pediatrics · doi:10.1016/j.acap.2010.04.006 · Cited by 1 · see citing works
Flagged first, then by citations
1 of the 56 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [14]14. N Y State J Med. 1989;89(8):457-461.
Cited by
Sorted by citations
Ahmed, N., Devitt, K. S., Keshet, I., Spicer, J., Imrie, K., Feldman, L., Cools-Lartigue, J., Kayssi, A., Lipsman, N., Elmi, M., et al. (2014) · Annals of Surgery · doi:10.1097/sla.0000000000000595 · Cited by 516 · see citing works
National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training
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., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1515724 · Cited by 460 · see citing works
Early Subspecialization and Perceived Competence in Surgical Training: Are Residents Ready?
Coleman, J. J., Esposito, T. J., Rozycki, G. S., & Feliciano, D. V. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2012.12.045 · Cited by 266 · see citing works
Mansukhani, M. P., Kolla, B. P., Surani, S., Varon, J., & Ramar, K. (2012) · Postgraduate Medicine · doi:10.3810/pgm.2012.07.2583 · Cited by 227 · see citing works
Antiel, R. M., Reed, D. A., Van Arendonk, K. J., Wightman, S. C., Hall, D. E., Porterfield, J. R., Horvath, K. D., Terhune, K. P., Tarpley, J. L., & Farley, D. R. (2013) · JAMA Surgery · doi:10.1001/jamasurg.2013.1368 · Cited by 185 · see citing works
Self-citationThe Utilization of Video Technology in Surgical Education: A Systematic Review
Green, J. L., Suresh, V., Bittar, P. G., Ledbetter, L., Mithani, S. K., & Allori, A. C. (2018) · Journal of Surgical Research · doi:10.1016/j.jss.2018.09.015 · Cited by 140 · see citing works
Rajaram, R., Chung, J. W., Jones, A. T., Cohen, M. E., Dahlke, A. R., Ko, C. Y., Tarpley, J. L., Lewis, F. R., Hoyt, D. B., & Bilimoria, K. Y. (2014) · JAMA · doi:10.1001/jama.2014.15277 · Cited by 139 · see citing works
Bilimoria, K. Y., Chung, J. W., Hedges, L. V., Dahlke, A. R., Love, R., Cohen, M. E., Tarpley, J., Mellinger, J., Mahvi, D. M., Kelz, R. R., et al. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2015.4990 · Cited by 87 · see citing works
Fronza, J. S., Prystowsky, J. B., DaRosa, D. A., & Fryer, J. P. (2012) · Journal of surgical education · doi:10.1016/j.jsurg.2012.05.014 · Cited by 83 · see citing works
Wohlauer, M. V., Arora, V. M., Horwitz, L. I., Bass, E. J., Mahar, S. E., & Philibert, I. (2012) · Academic Medicine · doi:10.1097/acm.0b013e318248e766 · Cited by 80 · see citing works
Drake, F. T., Eaton, E. G. V., Huntington, C. R., Jurkovich, G. J., Aarabi, S., & Gow, K. W. (2012) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e318270d983 · Cited by 75 · see citing works
Jamal, M. H., Wong, S., & Whalen, T. V. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-s1-s14 · Cited by 75 · see citing works
Alvand, A., Logishetty, K., Middleton, R. M., Khan, T. R., Jackson, W. F. M., Price, A. J., & Rees, J. L. (2013) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2013.01.026 · Cited by 65 · see citing works
Middleton, R. M., Alvand, A., Roberts, P. G., Hargrove, C., Kirby, G., & Rees, J. L. (2017) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2016.10.021 · Cited by 54 · see citing works
The ACGME case log: General surgery resident experience in pediatric surgery
Gow, K. W., Drake, F. T., Aarabi, S., & Waldhausen, J. H. T. (2013) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2012.09.027 · Cited by 51 · see citing works
Thanarajasingam, U., McDonald, F. S., Halvorsen, A. J., Naessens, J. M., Cabanela, R. L., Johnson, M. G., Daniels, P. R., Williams, A. W., & Reed, D. A. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2011.12.012 · Cited by 48 · see citing works
Self-citationAntiel, R. M., Arendonk, K. J. V., Reed, D. A., Terhune, K. P., Tarpley, J. L., Porterfield, J. R., Hall, D. E., Joyce, D. L., Wightman, S. C., Horvath, K. D., et al. (2012) · Archives of Surgery · doi:10.1001/archsurg.2012.89 · Cited by 48 · see citing works
Self-citationCordero, L., Hart, B. J., Hardin, R., Mahan, J. D., & Nankervis, C. A. (2013) · Clinical Pediatrics · doi:10.1177/0009922813488646 · Cited by 47 · see citing works
Szymczak, J. E., & Bosk, C. L. (2012) · Journal of Health and Social Behavior · doi:10.1177/0022146512451130 · Cited by 46 · see citing works
McLaren, K., Lord, J., Murray, S. B., Levy, M. R., Ciechanowski, P. S., Markman, J., Ratzliff, A., Cowley, D. S., & Grodesky, M. J. (2013) · Perspectives on Medical Education · doi:10.1007/s40037-013-0058-z · Cited by 42 · see citing works
Bommer, C., Sullivan, S. A., Campbell, K. K., Ahola, Z., Agarwal, S., O’Rourke, A. P., Jung, H. S., Gibson, A. L. F., LEVERSON, G. E., & Liepert, A. E. (2017) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2017.09.038 · Cited by 41 · see citing works
Anticipated Consequences of the 2011 Duty Hours Standards
Shea, J. A., Willett, L. L., Borman, K. R., Itani, K. M. F., McDonald, F. S., Call, S., Chaudhry, S. I., Adams, M. R., Chacko, K. M., Volpp, K. G. M., et al. (2012) · Academic Medicine · doi:10.1097/acm.0b013e3182584118 · Cited by 38 · see citing works
Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum
Tapia, N. M., Milewicz, A. L., Whitney, S. E., Liang, M. K., & Braxton, C. C. (2014) · JAMA Surgery · doi:10.1001/jamasurg.2013.4406 · Cited by 36 · see citing works
Use of a Night Float System to Comply With Resident Duty Hours Restrictions
Sun, N., Gan, R., Snell, L. S., & Dolmans, D. H. J. M. (2015) · Academic Medicine · doi:10.1097/acm.0000000000000949 · Cited by 34 · see citing works
Physician health: A review of lifestyle behaviors and preventive health care among physicians
Tyzuk, K. (2014) · Cited by 34 · see citing works
Truglio, J., Graziano, M., Vedanthan, R., Hahn, S. A., Rios, C. J. G., Hendel-Paterson, B. R., & Ripp, J. (2012) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.21327 · Cited by 34 · see citing works
Cowley, D. S., Markman, J. D., Best, J. A., Greenberg, E. L., Grodesky, M. J., Murray, S. B., Corning, K. A., Levy, M. R., & Greenberg, W. E. (2017) · Perspectives on Medical Education · doi:10.1007/s40037-017-0389-2 · Cited by 30 · see citing works
A Narrative Review of Surgical Resident Duty Hour Limits: Where Do We Go From Here?
Fabricant, P. D., Dy, C. J., Dare, D. M., & Bostrom, M. P. (2013) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-12-00081.1 · Cited by 30 · see citing works
SESC Practice Committee Survey: Surgical Practice in the Duty-hour Restriction Era
Nakayama, D. K., & Taylor, S. M. (2013) · The American Surgeon · doi:10.1177/000313481307900716 · Cited by 29 · see citing works
Associations between attending physician workload, teaching effectiveness, and patient safety
Wingo, M. T., Halvorsen, A. J., Beckman, T. J., Johnson, M. G., & Reed, D. A. (2016) · Journal of Hospital Medicine · doi:10.1002/jhm.2540 · Cited by 29 · see citing works
Self-citationEffect of the ACGME 16-Hour Rule on Efficiency and Quality of Care: Duty Hours 2.0
Choma, N. N., Vasilevskis, E. E., Sponsler, K. C., Hathaway, J., & Kripalani, S. B. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.3014 · Cited by 26 · see citing works
Barry, J. S., Gibbs, M. D., & Rosenberg, A. A. (2012) · Journal of Perinatology · doi:10.1038/jp.2012.27 · Cited by 25 · see citing works
Delinking resident duty hours from patient safety
Osborne, R., & Parshuram, C. S. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-s1-s2 · Cited by 24 · see citing works
Clegg, H. W., Giftos, P. M., Anderson, W. E., Kaplan, E. L., & Johnson, D. R. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.05.034 · Cited by 22 · see citing works
Lifchez, S. D., & Redett, R. J. (2014) · Journal of surgical education · doi:10.1016/j.jsurg.2013.09.010 · Cited by 21 · see citing works
Ahmed, H. M., Gale, S. C., Tinti, M. S., Shiroff, A. M., Macias, A. C., Rhodes, S. C., DeFreese, M., & Gracias, V. H. (2012) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e318265f984 · Cited by 20 · see citing works
The Perceived Effect of Duty Hour Restrictions on Learning Opportunities in the Intensive Care Unit
Sabri, N., Sun, N., Cummings, B., & Jayaraman, D. (2015) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-14-00180.1 · Cited by 20 · see citing works
Nadler, A., Ashamalla, S., Escallón, J., Ahmed, N. A., & Wright, F. C. (2014) · Journal of surgical education · doi:10.1016/j.jsurg.2014.10.001 · Cited by 19 · see citing works
Rajaram, R., Saadat, L. V., Chung, J. W., Dahlke, A. R., Yang, A. D., Odell, D. D., & Bilimoria, K. Y. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004794 · Cited by 19 · see citing works
Scheduling in the context of resident duty hour reform
Sun, N., & Maniatis, T. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-s1-s18 · Cited by 17 · see citing works
Dietl, C. A., & RUSSELL, J. C. (2016) · Journal of surgical education · doi:10.1016/j.jsurg.2016.03.016 · Cited by 17 · see citing works
Length of Attending-Student and Resident-Student Interactions in the Inpatient Medicine Clerkship
Osman, N. Y., Walling, J. L., Mitchell, V. G., & Alexander, E. K. (2015) · Teaching and Learning in Medicine · doi:10.1080/10401334.2015.1011655 · Cited by 16 · see citing works
Lessons Learned to Aid in Developing Fatigue Risk Management Plans for Resident Physicians
Kassam, A., Cowan, M., & Topps, M. H. (2018) · Teaching and Learning in Medicine · doi:10.1080/10401334.2018.1542307 · Cited by 16 · see citing works
Yuan, J., Huang, Y., Rosgen, B. K., Donnelly, S., Lan, X., & Katz, S. J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291457 · Cited by 15 · see citing works
Factors impacting neurosurgery residents’ operative case volume: a nationwide survey
Burkhardt, E., Adeeb, N., Terrell, D. L., Proctor, C., Musmar, B., Griessenauer, C. J., Kosty, J. A., & Guthikonda, B. (2023) · Journal of neurosurgery · doi:10.3171/2023.5.jns222861 · Cited by 14 · see citing works
Resident fatigue in otolaryngology residents: a Web based survey
Nida, A. M., Googe, B. J., Lewis, A. F., & May, W. L. (2016) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2016.01.017 · Cited by 14 · see citing works
Factors Associated with Non-Compliance During 16-Hour Long Call Shifts
Gonzalo, J. D., Herzig, S. J., Reynolds, E. E., & Yang, J. J. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2047-z · Cited by 13 · see citing works
The ACGME’s 2011 Changes to Resident Duty Hours: Are They an Unfunded Mandate on Teaching Hospitals?
Romano, P. S., & Volpp, K. G. M. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1936-x · Cited by 13 · see citing works
Xue, M., Liu, P., Zhang, J., Sun, Y., Fang, Y., Yang, J., Zeng, C., Huang, B., Chen, X., Xie, M. Z., et al. (2024) · Journal of surgical education · doi:10.1016/j.jsurg.2024.05.015 · Cited by 11 · see citing works
Saadat, L. V., Dahlke, A. R., Rajaram, R., Kreutzer, L., Love, R. R., Odell, D. D., Bilimoria, K. Y., & Yang, A. D. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.03.026 · Cited by 9 · see citing works
Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study
Caulley, L., Quimby, A. E., Barrowman, N., Moreau, K. A., & Vaccani, J. (2016) · Journal of surgical education · doi:10.1016/j.jsurg.2016.08.019 · Cited by 9 · see citing works
Surgery Website as a 24/7 Adjunct to a Surgical Curriculum
Jyot, A., Baloul, M. S., Finnesgard, E. J., Allen, S. J., Naik, N. D., Ibarra, M. A. G., Abbott, E., Gas, B. L., Lara, F. J. C., Zeb, M. H., et al. (2017) · Journal of surgical education · doi:10.1016/j.jsurg.2017.09.019 · Cited by 9 · see citing works
Self-citationDuty Hours: Where Do We Go From Here?
Rockey, P. H. (2011) · Mayo Clinic Proceedings · doi:10.4065/mcp.2011.0086 · Cited by 9 · see citing works
Estimating Minimum Program Volume Needed to Train Surgeons: When 4 × 15 Really Equals 90
Chung, J. J., Obi, A. T., Chen, R., Lin, W., Sun, S., Chen, Z., Gulati, A., Xu, X., Pozehl, W., Seagull, F. J., et al. (2014) · Journal of surgical education · doi:10.1016/j.jsurg.2014.07.010 · Cited by 8 · see citing works
Paediatric oncology simulation training for resident education
Smink, G. M., Jeffe, D. B., Hayashi, R. J., Al-Hammadi, N. J., & Fehr, J. J. (2018) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2018-000347 · Cited by 8 · see citing works
Beyond 250: A Comprehensive Strategy to Maximize the Operative Experience for Junior Residents
Healy, J. M., Maxfield, M. W., Solomon, D. G., Longo, W. E., & Yoo, P. S. (2017) · Journal of surgical education · doi:10.1016/j.jsurg.2017.08.025 · Cited by 8 · see citing works
Changes in residents’ opportunities for experiential learning over time
Peets, A. D., & Stelfox, H. T. (2012) · Medical Education · doi:10.1111/medu.12014 · Cited by 7 · see citing works
Strategies identified by program directors to improve adoption of the CanMEDS framework
Gaboury, I., Ouellet, K., Xhignesse, M., & St‐Onge, C. (2018) · Canadian Medical Education Journal · doi:10.36834/cmej.43049 · Cited by 7 · see citing works
A perspective on paediatric surgical training: opportunities and challenges
Patel, N. C., & Loveland, J. (2018) · South African Journal of Surgery · doi:10.17159/2078-5151/2018/v56n1a2251 · Cited by 5 · see citing works
Urology residents on call: Investigating the workload and relevance of calls
Thériault, B., Marceau-Grimard, M., Blais, A., Fradet, V., Moore, K., & Cloutier, J. (2017) · Canadian Urological Association Journal · doi:10.5489/cuaj.4333 · Cited by 5 · see citing works
Marwaha, J. S., Drolet, B. C., Maddox, S. S., & Adams, C. A. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.01.009 · Cited by 5 · see citing works
A simple step to reduce radiation exposure in the NICU
Gordon, P. V., & Swanson, J. R. (2014) · Journal of Perinatology · doi:10.1038/jp.2013.147 · Cited by 5 · see citing works
Feig, B. A., & Hasso, A. N. (2012) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2012.07.007 · Cited by 4 · see citing works
East, J., Cator, A. D., Burns, E., O'Gara, T. L., Card, J., Cohn, A., & Macy, M. L. (2013) · Journal of Hospital Medicine · doi:10.1002/jhm.2097 · Cited by 4 · see citing works
E-Learning and Medical Residents, a Qualitative Perspective
Segerman, J., Crable, E. A., & Brodzinski, J. D. (2016) · ValpoScholar (Valparaiso University) · Cited by 4 · see citing works
Dietl, C. A., & RUSSELL, J. C. (2016) · Journal of surgical education · doi:10.1016/j.jsurg.2016.03.015 · Cited by 4 · see citing works
Rakinic, J. (2012) · Clinics in Colon and Rectal Surgery · doi:10.1055/s-0032-1322527 · Cited by 3 · see citing works
Use of the Electronic Health Record to Track Continuity of Care in Neurological Surgery Residency
Litofsky, N. S., Farooqui, A. A., Tanaka, T., & Norregaard, T. (2014) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-13-00294.1 · Cited by 3 · see citing works
The Times, They Are A-Changing: Maybe We Need To Change Too
Stain, S. C. (2011) · Mayo Clinic Proceedings · doi:10.4065/mcp.2011.0079 · Cited by 3 · see citing works
Hoskote, S. S., Nadkarni, G. N., Annapureddy, N., Shetty, A. A., & Fried, E. D. (2014) · Teaching and Learning in Medicine · doi:10.1080/10401334.2014.910458 · Cited by 2 · see citing works
Anderson, M. L., Ogunwale, A. N., Clark, B. A., Kilpatrick, C. C., & Mach, C. M. (2015) · Journal of surgical education · doi:10.1016/j.jsurg.2015.04.008 · Cited by 2 · see citing works
Curricular Elements for Circadian Rhythm and Sleep Disorders in Anesthesiology Training Programs
Bolden, N., & Strohl, K. P. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2012.11.008 · Cited by 2 · see citing works
Redesign of an Internal Medicine Ward Rotation: Operational Challenges and Outcomes
Pierce, J. R., Chang, B., Rogers, K. M., Jernigan, J., Fotieo, D., Kang, H., & Leverence, R. R. (2012) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-11-00092.1 · Cited by 2 · see citing works
Sharifabadi, A. D., Clarkin, C. L., & Doja, A. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063104 · Cited by 2 · see citing works
Competency Based Medical Education is Wrong for SurgeryPreprint
Blinman, T. A. (2017) · doi:10.31219/osf.io/kzrqp · Cited by 2 · see citing works
Oristrell, J., Oliva, J. C., Casanovas, A., Comet, R., Jordana, R., & Navarro, M. (2013) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2013.09.003 · Cited by 1 · see citing works
Oristrell, J., Oliva, J. C., Casanovas, A., Comet, R., Jordana, R., & Navarro, M. (2013) · Revista Clínica Española · doi:10.1016/j.rce.2013.07.010 · Cited by 1 · see citing works
Sultan, S., Kavanagh, E. P., & Hynes, N. (2016) · Springer eBooks · doi:10.1007/978-3-319-33745-6_55 · Cited by 1 · see citing works
Finn, K. M., Halvorsen, A. J., Chaudhry, S. I., Desai, S. V., Dupras, D. M., Reddy, S. T., Wahi‐Gururaj, S., Willett, L. L., & Zaas, A. K. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06109-1 · Cited by 1 · see citing works
Fleming, M. A., Etchill, E. W., Marsh, K. M., Abebrese, E. L., Mannoh, I., Gander, J. W., Garcia, A. V., & Levin, D. E. (2021) · Pediatric Surgery International · doi:10.1007/s00383-021-05037-3 · Cited by 1 · see citing works
Kopel, J. J., & Phy, M. P. (2019) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2018.1533311 · Cited by 1 · see citing works
El médico residente de urología como educador. Una intervención educativa participativa
Leyva-González, F. A., Leyva-Salas, C. A., Clavelina, F. J. F. G., Salas, F. A. L., & Sánchez, J. S. V. (2019) · Investigación en Educación Médica · doi:10.22201/facmed.20075057e.2019.31.18112 · Cited by 1 · see citing works
Commentary on: Demystifying the “July Effect” in Plastic Surgery: A Multi-Institutional Study
Kasten, S. J., & Cederna, P. S. (2017) · Aesthetic Surgery Journal · doi:10.1093/asj/sjx158 · Cited by 1 · see citing works
Think Broad, Act Lean: Implications of Residency Training and Duty Hour Changes on Health Care Costs
Tabibian, J. H. (2011) · Mayo Clinic Proceedings · doi:10.4065/mcp.2011.0179
2010 Duty Hour Standards: Seeing Beyond the Numeric Limits
Philibert, I., & Nasca, T. J. (2011) · Mayo Clinic Proceedings · doi:10.4065/mcp.2011.0163
Inconclusive Findings on Effects of Duty Hour Reduction
Moonesinghe, R., & Beard, J. (2011) · Mayo Clinic Proceedings · doi:10.4065/mcp.2011.0222
Patel, A. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.03.027
Medical Residents' Perceptions of an E-Learning Experience
Segerman, J., Crable, E. A., & Brodzinski, J. D. (2015)
Interns shall not sleep: the duty hours boomerang
Quan, S. F. (2017) · Southwest Journal of Pulmonary and Critical Care · doi:10.13175/swjpcc043-17
Stories of becoming an emergency medicine physician
Hussain, A. (2017) · The University of Queensland · doi:10.14264/uql.2017.927
The Physician Trainee Environment and its Associated Effects on Trainees and their Patients
Osborne, R. (2018) · TSpace (University of Toronto)
An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences
Wykowski, J. H., Kelly, M. E., Tong, H. H., Osobamiro, O. O., & Albert, T. J. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08399-7
Burnout factors among residents in surgical and non-surgical specialties: a scoping reviewPreprint
Wang, W. C., Biswas, A., Kirpalani, A., & Wang, P. Z. T. (2024) · Research Square · doi:10.21203/rs.3.rs-4584396/v1
Changing the Presentation of Overnight Admissions to Improve Teaching Rounds
Hudspeth, J. C., Bosch, N. A., Lowe, R., Simmons, R. P., Yadavalli, G., & Upadhyay, A. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-10015-9
Should live nonhuman animal use in residency training programs be uniform? A case and commentary
Harrington, C. L., & Angelos, P. (2025) · Global Surgical Education - Journal of the Association for Surgical Education · doi:10.1007/s44186-025-00428-9
Guinat, M., Pantet, O., Salathé, C., Stieger, G., Carel, D., Gachoud, D., & Piquilloud, L. (2026) · BMC Medical Education · doi:10.1186/s12909-026-09056-3
Pedagogical Approaches for Surgical Education
Ferrier-Barbut, É. (2022) · doi:10.70675/043bf326z7bc1z4feez892ez61be0383cd42
- Authors
- Antiel, R. M., Thompson, S. M., Hafferty, F. W., James, K. M., Tilburt, J. C., Bannon, M. P., Fischer, P. R., Farley, D. R., & Reed, D. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Reed, Darcy A.
- ORCID
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 86
- Issue
- 3
- Pages
- 185-191
- ISSN
- 0025-6196 (ISSN-L)
- PMC
- PMC3046937
- OpenAlex
- W2086129080
- Cited by
- 97
- References
- 56
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 6 · 2017: 10 · 2016: 10 · 2015: 9 · 2014: 13 · 2013: 13 · 2012: 16
- FWCI
- 17.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (UL1RR024150)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- duty hour restrictions, ACGME core competencies, graduate medical education, residency program directors, resident fatigue, competence development, professionalism, internal medicine residency, pediatric residency, general surgery residency
- MeSH terms
- Accreditation, Attitude of Health Personnel, Clinical Competence, Education, Medical, Graduate, Female, Humans, Internal Medicine, Internship and Residency, Male, Physician Executives, Middle Aged, Pediatrics, General Surgery, United States, Work Schedule Tolerance, Workload
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.
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.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
