Does restricting work hours hurt surgical training?

by Michael Smith

Life is better but the quality of surgical training has gone down in the wake of a Swiss law restricting surgical residents’ hours.

That was the view of both the residents and the surgical consultants who supervise them in a survey conducted by Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues.

Less than 9% of residents and less than 5% of surgical consultants saw the change — which went into effect Jan. 1, 2005 — as beneficial to surgical training, the researchers reported in the June issue of Archives of Surgery.

The issue of surgical residents’ work hours has been controversial for years, the researchers noted, with some critics suggesting that long shifts lead to medical errors that compromise patient safety while others argue that surgical skills can only be honed with intensive work.

In the U.S., all medical residents have been limited to 80 hours a week since 2003 and even that is too little to achieve mastery for those intending to be surgeons, a 2009 report said.

But the Swiss law goes further. Within a total of 50 hours, Oertli and colleagues noted, daily day and night work time has to be limited to 14 hours, including all breaks, and rest time each day must equal or exceed 11 consecutive hours. Residents can’t work more than two hours a day of overtime except in rare cases and overtime can’t exceed 140 hours a year.

To see how those restrictions affected training and patient care, the researchers surveyed residents and consultants in 52 of the country’s 93 surgical departments. Of the 281 residents and 337 consultants, 405 responded, they said.

Oertli and colleagues found:

* 62.8% of residents and 77.2% of consultants thought the 50-hour workweek had had a negative effect on surgical training. The difference was significant at P<0.001.
* Only 8.1% of residents and 4.9% of consultants saw the limits as benefiting surgical training.
* Most residents and consultants thought that operating time had gone down, at 76.9% and 73.4%, respectively.
* 73.8% of residents and 84.8% of consultants thought the overall operating room experience was negatively affected by the work hours.
* 43% of residents and 70.1% of consultants thought the quality of patient care had gone down. Again the difference between the two groups was significant at P<0.001.
* On the other hand, 58.4% of residents and 81.5% of consultants thought that residents’ quality of life had improved. The difference was significant at P<0.001.

“Despite somewhat improved resident quality of life,” Oertli and colleagues wrote, “the work hour limitation for surgical residencies in Switzerland appears to be a failure.”

The researchers noted that the study was anonymous, so they could not assess nonresponse bias by identifying nonresponders. And, they noted, the survey was conducted in a year after the limits were imposed and may “partially reflect the lack of adaptation to a new system.”

They added that the survey did not include patients or nurses, so there is no way to substantiate any perceived lack of continuity in physician care.

Michael Smith is a MedPage Today North American Correspondent.

Originally published in MedPage Today. Visit for more health policy news.

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