SynthesisJournal of graduate medical education2015
The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review.
Synthesis in Journal of graduate medical education, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 5 of them syntheses that pooled 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.
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.
Who cites it
99 citing papers in PubMed, 5 syntheses or guidelines pooled it, 253 citations in OpenAlex.
- Resident Physicians' Work-Related Emotional Experiences: A Scoping Review of Qualitative Research.Journal of general internal medicine · 2026Pooled it
- The impact of shortening shifts of physicians during their residency on patients and physicians : A systematic review and meta-analysis.Israel journal of health policy research · 2025Pooled it
- Healthy working time arrangements for healthcare personnel and patients: a systematic literature review.BMC health services research · 2019Pooled it
- Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review.BMJ open · 2018Pooled it
- Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review.Journal of graduate medical education · 2017Pooled it
- Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine.The New England journal of medicine · 2018Trial
- Review
- Implementing Night Float Systems for Nephrology Fellows: A National Survey of Nephrology Training Program Directors.Kidney medicine · 2026Article
- Circadian Biology and Phase Response: Fundamental Mechanisms and Clinical Applications.Clocks & sleep · 2026Review
- On-call work schedules, sleep knowledge, and sleep quality in medical trainees: results from a UK pilot study.Journal of thoracic disease · 2026Article
- Towards equity in healthcare workforce well-being: a framework for leaders to improve well-being and retention.BMJ leader · 2026Article
- The Erosion of Trainee Engagement in Critical Care: A Systems Problem or a Generational Failure?Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Within-person differences in night-shift burden and well-being after ICU versus non-ICU night shifts among resident physicians: a paired survey study.BMC medical education · 2026Article
- Work Hours, Stress, and Burnout Among Resident Physicians.JAMA network open · 2026Article
- Autistic- and attention-deficit/hyperactivity disorder-like traits: differential associations with burnout, depression and anxiety, and empathy among Japanese junior residents.Frontiers in psychiatry · 2026Article
- Safety in Numbers: A Scoping Review of Patient Census and Patient Outcomes.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Leaning into Necessary Discomforts: Striving for Clinical Excellence While Maintaining Wellness.ATS scholar · 2025Review
- The Recovery Deficit: A Simulation Model of Physician Performance Under Sleep Deprivation.Cureus · 2025Article
- Relationship between shift scheduling, sleep knowledge and sleep quality in medical trainees: protocol for a global cross-sectional survey.Journal of thoracic disease · 2025Article
- Association of the 2017 ACGME US Resident Duty Hour Policy Change With Hospital Quality and Patient Experience.Journal of graduate medical education · 2025Observational
39 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite 25 years of implementation and a sizable amount of research, the impact of resident duty hour restrictions on patients and residents still is unclear. Advocates interpret the research as necessitating immediate change; opponents draw competing conclusions.
objectiveThis study updates a systematic review of the literature on duty hour restrictions conducted 1 year prior to the implementation of the Accreditation Council for Graduate Medical Education's 2011 regulations.
methodsThe review draws on reports catalogued in MEDLINE and PreMEDLINE from 2010 to 2013. Interventions that dealt with the duty hour restrictions included night float, shortened shifts, and protected time for sleep. Outcomes were patient care, resident well-being, and resident education. Studies were excluded if they were not conducted in patient care settings.
resultsTwenty-seven studies met the inclusion criteria. Most frequently, the studies concluded that the restrictions had no impact on patient care (50%) or resident wellness (47%), and had a negative impact on resident education (64%). Night float was the most frequent means of implementing duty hour restrictions, yet it yielded the highest proportion of unfavorable findings.
conclusionsThis updated review, including 27 recent applicable studies, demonstrates that focusing on duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education. New approaches to the issue of physician fatigue and its relationship to patient care and resident education are needed.
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Registered trials
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.