One Year Later: Pediatric Program Directors? Perspectives on Implementation of ACGME Duty Hours Limitations

Holly J. Mulvey, MA ¹, William L Cull, PhD ¹ and Ethan AB Jewett, MA ¹. ¹ American Academy of Pediatrics, Elk Grove Village, IL, United States, 60007.

 

Background: Proposed federal regulation, driven by highly publicized concerns about resident fatigue and excessive duty hours, resulted in new ACGME requirements limiting duty hours to 80-hour weeks, averaged over a 4 week period, inclusive of all in-house call activities.

 

Objective: To examine program directors? experiences implementing the mandated duty hour limits and to assess the perceived impact of the limits on resident fatigue and pediatric residency education.

 

Design/Methods: In June 2004 an 18-question survey was sent to members of the Association of Pediatric Program Directors (n=194). After 3 mailings, 161 program directors responded (83 % response rate). Programs were divided into two groups: large (> 15 residents/class) and small (< 15 residents/class) for analysis.

 

Results: When asked about their overall reaction to the new ACGME duty hours limits, 39% of program directors reported positive reactions, 34% were neutral, and 27% reported negative reactions. Program directors from large and small programs had similar reactions to the limits (p = .825). Most program directors (56%) reported minimal to no difficulty in complying with the duty hour limits. Only 6% reported considerable difficulty. The most frequent change made in response to the new limits was asking attending physicians to work longer hours (45%), while 42% implemented night float.

Of the respondents, 72% thought that sleep deprivation was probably or definitely not a problem in their program, and 74% reported that residents received information or formal presentations on the effects of sleep deprivation. Also, 81% thought that moonlighting probably or definitely did not contribute to resident fatigue in their programs.

Ninety-four percent thought federal legislation should not regulate resident duty hours, while 89% felt the current system (including ACGME and institutional mechanisms) is effective or very effective in ensuring appropriate duty hours.

 

Conclusions: Pediatric program directors have had positive reactions to implementing the ACGME duty hours limitations. Possible negative impact of the duty hours limits on continuity of patient care and quality of resident education are concerns that will need to be closely monitored.