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  • Publication # 14-RA002

Trauma surgery resident experience declined over a decade prior to the 2003 work-hour reform

Patient Safety and Quality

General surgery medical residents need to participate in a minimum of 10 operative trauma cases during their training. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented new work-hour rules for U.S. residency programs that limited all house staff to working 80 hours each week. 

A study exploring the impact of this reform on operative trauma cases found that overall trauma cases per year declined from 78.28 per surgical resident to 38.73 between 1990 and 2010 by 3.41 cases per year. However, during the period following the work-hour change (2003–2010), overall trauma cases increased by 0.36 cases per year. The percentage of junior surgical residents involved in trauma operative cases had risen from 67 percent in 1990 to 79 percent in 2010, meaning that chief residents (residents in their final year of training) were less likely to be participating in trauma cases.

General surgery medical residents.As part of this trend, the percentage of total trauma vascular cases experienced by a junior resident increased from 47 percent in 1990 to 62 percent in 2003–2004, to 75 percent in 2010 and, for thoracic cases, from 60 percent in 1990 to 69 percent in 2003–2004 to 75 percent in 2010. 

The researchers conclude that secular trends before the 2003 work-hour reform caused a 50 percent decrease in operative trauma experience among general surgery residents. After work-hour reform, operative trauma case volumes stabilized, although cases were increasingly transferred to junior residents. This study was supported by AHRQ (HS13833). 

See "Twenty-year analysis of surgical resident operative trauma experiences," by Mayur B. Patel, M.D., M.P.H., Oscar D. Guillamondegui, M.D., M.P.H., Addison K. May, M.D., and Jose J. Diaz, M.D., in the Journal of Surgical Research 180, pp. 1911-1915, 2013.


Page last reviewed November 2013
Internet Citation: Trauma surgery resident experience declined over a decade prior to the 2003 work-hour reform: Patient Safety and Quality. November 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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