Maintaining outcomes in a surgical residency while complying with resident working hour regulations☆

Background: Regulatory requirements for resident working hours were designed to improve patient care. Compliance challenges a training program to meet procedural and clinical requirements. This is a retrospective study of a 5-year experience in addressing the challenges and studying the impact of compliance on resident caseload and board performance. Methods: Our surgical program adopted strict start/stop working hours for clinical contact. Program leadership modified the program to establish procedural and performance criteria. Procedures were prioritized and assignments were changed to maximize clinical and procedural experience while reducing redundancy of experience. Procedural activity was monitored frequently. Compliance with working hour regulations was monitored and behavior modified where necessary. A web based computer program was developed to improve measurement of compliance and provide feedback. Outcome measures included both the number of procedures as reported by the ACGME and performance on the American Board of Surgery, Qualifying Examination. Results: Working hour compliance is greater than 95%. First time pass rate on the Qualifying examination is 90% (45/50). There is no significant difference in the procedural activity. Conclusion: Complying with working hour regulations improves the quality of a resident's life and can be achieved while maintaining procedural experience and guaranteeing academic development. Surgery 2002;132:635-41.