The scope of duty hour–associated residency structure modifications

Objective The purpose of this study was to characterize the duty hours–associated modifications made to the educational and patient care structure of obstetrics and gynecology residency programs, and the relationship of these modifications to residency program setting and size. Study design A survey of accredited obstetrics and gynecology residency programs in the United States (excluding New York State) was performed between June 21st and July 16th, 2004. Program representatives were queried on the difficulty encountered in complying with each of the 6 components of the ACGME common duty hour requirements and the prevalence of residency modifications affecting the educational and patient care structure. Results Fifty-eight percent (123/211) of the study population completed the questionnaire. Ensuring a minimum 10-hour rest period between shifts was rated the most difficult requirement. Ninety-eight percent of respondents reported various types of modifications to program structure, including modification of on-call structure (94%), redistribution of responsibilities among resident levels (85%), modification of resident participation in patient care processes (80%), and modification of resident assignments to clinical services (75%). A minimum of 38% of programs reported reductions in resident participation in patient care, regardless of clinical service type or care setting. The prevalence of hiring attending physicians was significantly higher among non–university-based programs (18%), compared to university-based programs (3%, P = .007). Conclusion Duty hour–related changes have resulted in near universal program modifications. One third of programs have made modifications that have resulted in a decrease in the available clinical experiences for residents.