Evidence map›Paper›PMID 29557719›Full record

Trial reportThe New England journal of medicine2018

Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine.

Sanjay V Desai, David A Asch, Lisa M Bellini, Krisda H Chaiyachati, Manqing Liu, Alice L Sternberg, James Tonascia, Alyssa M Yeager, Jeremy M Asch, Joel T Katz and 11 more

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02274818 (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education), which is not on this map. Cited by 87 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 4 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.

NCT02274818 nacompletednot on this map

Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE).

TypeinterventionalSponsorUniversity of PennsylvaniaRan2015 to 2020Enrolled3,500ConditionsSafety, Education, Medical, SleepArmsFlexible Duty Hour Schedule
3 · Its place in the literature

Who cites it

87 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022
    Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Review
  16. Article
  17. Article
  18. Observational
  19. Article
  20. Article

27 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Sanjay V DesaiFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
David A AschFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Lisa M BelliniFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Krisda H ChaiyachatiFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).ORCID 0000-0003-3326-6641
Manqing LiuFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Alice L SternbergFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
James TonasciaFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Alyssa M YeagerFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Jeremy M AschFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Joel T KatzFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Mathias BasnerFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
David W BatesFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Karl Y BilimoriaFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
David F DingesFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Orit Even-ShoshanFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
David M ShadeFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Jeffrey H SilberFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Dylan S SmallFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Kevin G VolppFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
Judy A SheaFrom the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.).
iCOMPARE Research Group

Funding

ICOMPARE-CCCU01HL125388 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI ASCH, DAVID A · 2015 to 2018
$5.7M
iCOMPARE - DCCU01HL126088 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI TONASCIA, JAMES A · 2015 to 2018
$3.4M
NHLBI NIH HHS U01 HL125388NHLBI NIH HHS U01 HL126088
6 · The paper itself

Abstract

backgroundConcern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians.

methodsWe randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores.

resultsThere were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees' perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by program directors and faculty of whether trainees' workload exceeded their capacity (primary outcome for faculty satisfaction with education; response rate, 90%). Another survey of interns (response rate, 49%) revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality (odds ratio, 1.67; 95% confidence interval [CI], 1.02 to 2.73) and overall well-being (odds ratio, 2.47; 95% CI, 1.67 to 3.65). In contrast, directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching (response rate, 98%; odds ratio, 0.13; 95% CI, 0.03 to 0.49). Average scores (percent correct answers) on in-training examinations were 68.9% in flexible programs and 69.4% in standard programs; the difference did not meet the noninferiority margin of 2 percentage points (difference, -0.43; 95% CI, -2.38 to 1.52; P=0.06 for noninferiority). od Institute and the ACGME; iCOMPARE ClinicalTrials.gov number, NCT02274818 .).

conclusionsThere was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies. Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs, but program directors were more satisfied. (Funded by the National Heart, Lung, and Blo

Indexed as

Attitude of Health PersonnelClinical CompetenceHospital AdministratorsBurnout, ProfessionalContinuity of Patient CareFaculty, MedicalHumansInternal MedicineInternship and ResidencyJob SatisfactionMedical Staff, HospitalPersonnel Staffing and SchedulingSurveys and QuestionnairesTime and Motion StudiesUnited StatesWorkload

Identifiers

PMID29557719
PMCPMC6101652

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.