Evidence map›Paper›PMID 24662409›Full record

SynthesisAnnals of surgery2014

A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes.

Najma Ahmed, Katharine S Devitt, Itay Keshet, Jonathan Spicer, Kevin Imrie, Liane Feldman, Jonathan Cools-Lartigue, Ahmed Kayssi, Nir Lipsman, Maryam Elmi and 8 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of surgery, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 148 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
148citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

148 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  16. Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015
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88 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Najma Ahmed*Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Internal Medicine, Mount Sinai Hospital, New York City, NY ‡Department of Surgery, McGill University, Montreal, Quebec, Canada §Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada ‖Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada ¶Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada **Department of Surgery, Royal Inland Hospital, Kamloops, British Columbia, Canada.
Katharine S Devitt
Itay Keshet
Jonathan Spicer
Kevin Imrie
Liane Feldman
Jonathan Cools-Lartigue
Ahmed Kayssi
Nir Lipsman
Maryam Elmi
Abhaya V Kulkarni
Chris Parshuram
Todd Mainprize
Richard J Warren
Paola Fata
M Sean Gorman
Stan Feinberg
James Rutka

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery.

methodsA systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality.

resultsA total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented.

conclusionsRecent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.

Indexed as

Internship and ResidencyWork Schedule ToleranceEducational MeasurementEducation, Medical, GraduateGeneral SurgeryHumansPatient SafetyWorkload

Identifiers

PMID24662409
PMCPMC4047317

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.