Work hour restrictions: impact on neurosurgical resident training at the University of Utah

Resident work hour restrictions imposed by the Accreditation Council for Graduate Medical Education became effective on July 1, 2003. To evaluate the effect of these regulations on resident operative experience, we reviewed and compared the surgical experience of junior and senior neurosurgical residents four years before and one year after the ACGME restrictions were implemented. Resident work hours since May 2003 and operative caseload during the study period were recorded in commercially available data systems. The mean number of hours worked per week by junior and chief residents decreased f r om 104 and 110 hours before the ACGME work hour restrictions to 81 and 84 hours afterward, respectively. During the four academic years before the work hour limitations took effect, the mean number of major cases performed each year was 802.5 for the chief residents and 849.3 for t he junior residents. Following the restrictions, little changed for t he chief residents. However, the junior residents averaged only 467 cases, a 45 percent decrease f r om t he previous years studied. The mean number of cases covered by each junior resident per month decreased by 30.5 percent after the work hour restrictions were instituted, and the mean number of cases covered per post-call junior resident in one month declined 47.8 percent, from 23 to 12. At our institution, the ACGME work hour restrictions have resulted in decreased resident work hours for all residents at t he expense of the operative experience for junior residents. The operative caseload for chief residents has not been affected.