Revisiting the Rotating Call Schedule in Less Than 80 Hours Per Week

• Published in: Journal of surgical education 2009-11, Vol.66 (6), p.357-360
• Main Authors: Roses, Robert E., MD, Foley, Paul J., MD, Paulson, Emily C., MD, Pray, Lori, BA, Kelz, Rachel R., MD, Williams, Noel N., MD, Morris, Jon B., MD
• Format: Article
• Language: English
• Subjects: Education, Medical, Graduate - organization & administration; Female; General Surgery - education; Hospitals, University; Humans; Internship and Residency - organization & administration; Male; Patient Care; Personnel Staffing and Scheduling - trends; Professionalism; Quality of Health Care; Surgery; Surgery Department, Hospital; Systems Based Practice; Time Factors; Work Schedule Tolerance; Workload
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2009.07.005

Purpose The Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions have prompted many surgical training programs to adopt a night-float resident coverage system (NF). Dissatisfaction with NF prompted us to transition to a rotating junior resident call model (Q4) with 24-hour call shifts at the outset of the 2007-2008 academic year. We performed a prospective study to determine the influence of this transition on resident education, morale, and quality of life, as well as on ACGME work rule compliance and American Board of Surgery In-Training Examination (ABSITE) scores. Methods Residents were surveyed after 1 year of NF and again 1 year after the introduction of Q4. Responses to a series of statements about the influence of the call model (NF or Q4) on educational opportunities and morale were solicited. The survey used a 5-point Likert response scale (1 = complete disagreement to 5 = complete agreement). Median values of participant responses were calculated and compared using the Wilcoxon rank-sum test. Compliance with ACGME work rules, ABSITE scores, and operative case logs from the 2006-2007 and 2007-2008 academic years were also compared. Results Residents were significantly more enthusiastic about Q4 compared with NF, particularly when asked about the influence these systems had on morale (median response = 4.0 [Q4] compared with 2.0 [NF]; p = 0.001) and engagement of residents by the teaching faculty (median response = 4.0 [Q4] compared with 1.0 [NF]; p = 0.001). Case logs revealed a similar operative experience for first-year residents irrespective of the call schedule (p = 0.51). Excellent compliance with ACGME work rules was maintained as reflected by the percentage of monthly 80-hour violations per resident months worked (3% [Q4] compared with 0.7% [NF]). No difference was observed in the ABSITE scores of first-year residents (a mean percentile point increase of 1 was found after the introduction of Q4). Conclusions Educational opportunities, compliance with ACGME work rules, and ABSITE scores can be preserved despite a transition from NF to Q4. Residents greatly prefer a rotating call schedule.