Patient Perceptions of Whom is Most Involved in Their Care with Successive Duty Hour Limits

Abstract

Background: Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours.

Objective: We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours.

Design: This was a prospective observational study over 12 years at a single institution.

Participants: Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview.

Main measures: Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011).

Key results: With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p < 0.001). Simultaneously, fewer patients reported a housestaff physician (resident or intern) as most involved in their care (pre-2003 20 %, post-2003-pre-2011 17 %, post-2011 12 %, p < 0.001). In multinomial regression models controlling for patient age, race, gender and hospitalist as teaching attending, the relative risk ratio of naming the resident versus the attending was higher in the pre-2003 period (1.44, 95 % CI 1.28-1.62, p < 0.001) than the post-2003-pre-2011 (reference group). In contrast, the relative risk ratio for naming the resident versus the attending was lower in the post-2011 period (0.79, 95 % CI 0.68-0.93, p = 0.004) compared to the reference group.

Conclusions: After successive residency duty hours limits, hospitalized patients were more likely to report the attending physician and less likely to report the resident or intern as most involved in their hospital care. Given the importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.

Figure 1.

Percentage of patients who identified attending or housestaff as most involved in their hospital care with successive duty hour restrictions (n = 22,750).

Figure 2.

Percentage of patients who identified attending as most involved with their care by year (n = 22,750). The figure shows that the fraction of patients who answered the attending was most involved in their hospital care. In the 2 years after implementation of 2003 duty hours in the academic year ending in 2006, noncompliance with duty hours was higher until services were restructured in the academic year ending in 2006 to include a day float resident. In the academic year ending in 2011 that preceded implementation of July 2011 duty hours, service structures were phased in early in anticipation of the 2011 duty hours.