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• W2047768834 abstract "Introduction: The Accreditation Council for Graduate Medical Education (ACGME) implemented new work hour rules for all U.S. residency programs beginning on July 1, 2003, limiting all housestaff to working 80 hours each week. This led to a significant shift in the culture and workflow of American teaching hospitals, and may have impacted the training of general surgery residents, who often worked many hours in excess of this limit prior to the ACGME regulations. the aim of this study is to assess the impact of the ACGME-mandated work hour reform on operative trauma case volume of graduating general surgery residents. Methods: We employed an interrupted time series to examine trends in resident trauma operative volume during the pre-policy period, 1990 - 2003, against the post-policy period, 2004 - 2010. Our process outcome is represented as operative trauma case volume normalized per the number of graduating residents for each year. Using aggregate data collected from the ACGME accredited general surgery residency programs from 1990 - 2010, we examined the effect of resident work hour reform initiated in the 2003 academic year. Trauma case subtypes with stable longitudinal case definitions were analyzed with simple linear regression statistics using STATA IC/11.1. Results: Overall trauma cases/year declined from 78.28 in 1990 to 38.73 in 2010. from 1990-2003, exploratory laparotomy, burn, and upper GI trauma cases fell at least 50%, from 9.97 to 4.85 cases/resident by 0.46 cases/year [95% CI: 0.456-0.459], 10.05 to 3.30 cases/resident by 0.61 cases/year [95% CI: 0.609-0.617], and 3.34 to 1.01 cases/resident by 0.189 cases/year [95% CI: 0.188-0.189] respectively. After 2003, laparotomy and burn cases have both begun to rise by 0.23 cases/year [95% CI: 0.228-0.231] and 0.36 cases/year [95% CI: 0.358-0.368]. Vascular trauma cases have continued to decline from a peak of 8.63 cases/resident by 0.197 [95% CI: 0.196-0.198] pre-reform, but by 0.102 [95% CI: 0.099-0.105] post-reform. Spleen, liver, thoracic, cardiac, pancreatic, and genitourinary (GU) trauma cases experienced similar larger pre-reform declines. Cardiac, pancreatic, and GU cases have never peaked more than 1.95 cases/resident pre-reform. Small bowel and colon operative trauma manifest non-linear declines, but has stabilized at 4.60 cases/resident by 2010. Conclusions: Secular trends prior to the 2003 work hour reform may have caused a marked decrease in operative trauma experience among general surgery residents. Radiologic advancements in intervention and imaging may have had a role in this decline. Rare cases, such as cardiac, pancreatic, and GU trauma, remain rare. Post work hour reform, operative trauma case volumes have stabilized." @default.
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• W2047768834 date "2012-02-01" @default.
• W2047768834 modified "2023-09-27" @default.
• W2047768834 title "A Nationwide Twenty Year Analysis of Resident Operative Trauma Experiences: Pre & Post Work Hour Reform" @default.
• W2047768834 doi "https://doi.org/10.1016/j.jss.2011.11.576" @default.
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