Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 1;20(1):16-21.
doi: 10.1097/PTS.0000000000001175. Epub 2023 Oct 25.

Factors Affecting Medical Residents' Decisions to Work After Call

Michele M Carr  1 , Anne M Foreman  2 , Jonathan E Friedel  3 , Daniel C O'Brien  4 , Oliver Wirth  2
Affiliations

Factors Affecting Medical Residents' Decisions to Work After Call

Michele M Carr et al. J Patient Saf. .

Abstract

Background: Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs) are intended to improve patient safety by reducing resident fatigue. Compliance with ACGME WHRs is not universal.

Purpose: The purpose of this study was to identify factors that influence residents' decisions to take a postcall day (PCD) off according to ACGME WHRs.

Methods: Residents (N = 433) at one university were emailed a link to a survey in 2019. The survey included demographic details and a Discrete Choice Experiment examining influences on resident decisions to take a PCD off.

Results: One hundred seventy-five residents (40.4%) responded to the survey; 113 residents (26%) completed the survey. Positive feedback from attending physicians about taking PCDs off in the past had the greatest impact on respondents' decisions to take a PCD off, increasing the probability by 27.3%, followed by chief resident comments about the resident looking tired (16.6% increase), and having never heard their attendings comment about PCDs off as either positive or negative (13.9% increase). Factors that had the largest effect on decreasing the probability of taking a PCD were negative feedback about taking PCDs off (14.3% decrease), continuity of care concerns (10.8% decrease), and whether the resident was looking forward to an assignment (7.9% decrease).

Conclusions: The most important influencer of residents' decisions to take a PCD off was related to feedback from their attending physicians, suggesting that compliance with WHRs can be improved by focusing on the residency program's safety culture.

PubMed Disclaimer

Conflict of interest statement

The authors disclose no conflict of interest.

Figures

Figure 1.
Figure 1.
A screenshot of a DCE question presented to participants during the survey.
Figure 2.
Figure 2.
The percent change in the probability of the choice to take a post-call day off in comparison to the base case. PCD = Post-Call Day
See this image and copyright information in PMC

References

    1. Holzman IR, Barnett SH. The Bell Commission: ethical implications for the training of physicians. Mt Sinai J Med. 2000. Mar;67(2):136–9. - PubMed
    1. Accreditation Council for Graduate Medical Education (ACGME). The Program Directors’ Guide to the Common Program Requirements (Residency), Editorial Revision 1, updated January 31 2020. https://www.acgme.org/Portals/0/PFAssets/ProgramResources/PDGuideResiden.... Accessed 10 August 2021.
    1. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature. 1997;388:235. - PubMed
    1. Jackson ML, Croft RJ, Kennedy GA, Owens K, Howard ME. Cognitive components of simulated driving performance: sleep loss effects and predictors. Accid Anal Prev. 2013;50:438–444. - PubMed
    1. Wagstaff AS, Signstad Lie JA. Shift and night work and long working hours: a systematic review of safety implications. Scand J Work Environ Health. 2001;37:173–185. - PubMed

Publication types

LinkOut - more resources