HealthDay News — Flexible, less-restrictive, duty-hour policies are not associated with worse patient outcomes or resident satisfaction compared with standard duty-hour policies, according to a study published in the New England Journal of Medicine. The finding were published to coincide with the annual Academic Surgical Congress, held from Feb. 2 to 4 in Jacksonville, Fla.

Karl Y. Bilimoria, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a national, cluster-randomized trial involving 117 general surgery residency programs. Programs were randomized to current Accreditation Council for Graduate Medical Education duty-hour policies or more flexible policies. Data were analyzed for 138 691 patients and for 4330 residents.

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The researchers found that flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications compared with the standard-policy group (9.1 versus 9.0%; P = 0.92; noninferiority criteria satisfied). 

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There was also no increased rate of any secondary postoperative outcomes studied with less-restrictive policies. 

Residents assigned to the flexible-policy programs did not report significantly greater dissatisfaction with overall educational quality or well-being compared with the standard-policy group (11.0 versus 10.7 [P = 0.86] and 14.9 versus 12.0% [P = 0.10], respectively).

“As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents’ satisfaction with overall well-being and education quality,” the authors write.


Bilimoria KY, Chung JW, Hedges LV, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med. 2016. doi:10.1056/NEJMoa1515724.