Four National Groups of Surgeons Respond to the Institute of Medicine’s Recommendation for Reduction of Resident Duty Hours Restrictions on Hours Perceived as Detrimental to Patient Care and Surgical Education

Philadelphia, PA, 7 October 2009 - Ever since the Accreditation Council for Graduate Medical Educations (ACGME) and its Resident Review Committees instituted limitations on duty-hours for residents, in 2003, there has been an ongoing debate about the benefits and costs of the changes imposed on patient care and the education of residents.

In a new special issue of SURGERY, published by Elsevier, four diverse professional groups of surgeons involved in training surgical residents, the certification of surgeons and the representative national body for the House of Surgery, and The American College of Surgeons (ACS), recommend multiple changes in the resident environment of training. This includes a reduction of the duty-hours standards proposed in 2003.

Surgery Editors-in-Chief Andrew L. Warshaw, MD, Massachusetts General Hospital Department of Surgery, and Michael G. Sarr, Mayo Clinic, comment on the response from the leadership of Surgery. “In this special issue, despite the different corners from which the comments come, the common themes and concerns are evident. The Editors’ intention is for the combined force of these statements to significantly elucidate and impact upon the debate.”

There are concerns that rigid work schedule recommendations are inconsistent with the realities of modern surgery. The reduced work hours compromise patient care by forcing handoffs from one surgeon to another and short-change surgical residents from fully experiencing the intensity that is often associated with and often implicit within their professional environment. Furthermore, uniform regulations undermine the specificity within surgical specialties and how this affects individual surgeons and their patients.

Frank R. Lewis, MD, Executive Director, American Board of Surgery, comments on the lack of consideration of the “effect of resident hour restrictions on surgical practice and surgical resident education.” This is a common theme that runs through this issue, and he continues to express the overarching perspective: “Flexibility needs to be introduced into the work hours requirements such that unique needs of different specialties can be accommodated, and the work hours can be made secondary to the primacy of patient care and the opportunities for resident learning.”


Notes to Editors:
The articles in the special issue are:

“Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: A response from the American College of Surgeons to the Report of the Institute of Medicine, ‘Resident Duty Hours: Enhancing Sleep, Supervision, and Safety’” by L. D. Britt, MD, MPH, FACS, Ajit K. Sachdeva, MD, FRCSC, FACS, Gerald B. Healy, MD, FACS, FRCSI (Hon), FRCSE (Hon), Thomas V. Whalen, MD, MMM, FACS, Patrice Gabler Blair, MPH, and Members of the ACS Task Force on Resident Duty Hours.

“Resident Duty Hours: Enhancing Sleep, Supervision, and Safety: Response of the Association of Program Directors in Surgery to the December 2008 Report of the Institute of Medicine” by Karen R. Borman, MD, and George M. Fuhrman, MD, on behalf of the Association.

“Comment of the American Board of Surgery on the recommendations of the Institute of Medicine Report: Resident Duty Hours: Enhancing Sleep, Supervision, and Safety” by Frank R. Lewis, MD, Executive Director, American Board of Surgery, Philadelphia, PA.

“Position statement on further work hour restrictions: The views of current and recent trainees” by Jacob Moalem, MD, Luke Brewster, MD, MS, and Ted James, MD.

The articles appear in Surgery, Volume 146, Issue 3 (September 2009), published by Elsevier.

For 68 years, Surgery has published practical, authoritative information about cutting edge procedures, clinical advances, and major trends shaping the practice of surgery education and research. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons. Visit the journal website at

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