Impact of the 80-hour workweek on surgical exposure and national in-training examination scores in an orthopedic residency program

Abstract

Objectives: This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period.

Methods: Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean +/- standard deviation (SD), and group means were compared using independent t-tests.

Results: No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally.

Conclusions: We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.