Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1805-e1811 (doi:10.1542/peds.2006-0210)

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ARTICLE

Pediatric Residency Duty Hours Before and After Limitations

William L. Cull, PhD^a, Holly J. Mulvey, MA^a, Ethan A. Jewett, MA^a, Edwin L. Zalneraitis, MD^b, Carl E. Allen, MD, PhD^c, Richard J. Pan, MD^d

^a American Academy of Pediatrics, Elk Grove Village, Illinois
^b Office of Pediatric Medical Education, University of Connecticut, Hartford, Connecticut
^c Department of Pediatrics, Division of Hematology-Oncology, Texas Children's Hospital, Houston, Texas
^d Department of Pediatrics, University of California, Davis, Sacramento, California

OBJECTIVES. The goals were to examine pediatric resident and program director experiences implementing the Accreditation Council for Graduate Medical Education work hour limits and to compare duty hours, moonlighting, and fatigue before and after the limits became effective.

METHODS. National random samples of 500 pediatric residents who graduated in 2002 and in 2004 were surveyed to compare resident duty hours and fatigue before and after the Accreditation Council for Graduate Medical Education limits were implemented. In addition, all US pediatric residency program directors were surveyed at the end of the 2003/2004 academic year, to provide a complementary retrospective examination of limit implementation.

RESULTS. Totals of 65%, 61%, and 83% of 2002 residents, 2004 residents, and program directors, respectively, responded. The proportion of residents who reported working >80 hours per week declined from 49% for NICU/PICU rotations before the limits to 18% after limit implementation. Resident well-being was the factor identified most often by both residents and program directors as being improved since the limitations. Multivariate modeling also showed reductions in the proportions of residents who reported falling asleep while driving from work or making errors in patient care because of fatigue. Overall, 89% of pediatric residents and program directors reported that the current system is effective in ensuring appropriate working hours.

CONCLUSIONS. Since the Accreditation Council for Graduate Medical Education duty hour limits went into effect, pediatric residents report working fewer hours and making fewer patient care errors because of fatigue. Although room for additional improvement remains, the experiences of residents and program directors suggest that implementation of the Accreditation Council for Graduate Medical Education limits in pediatric residency programs is improving resident well-being.

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Key Words: duty hour limits • residency training • resident fatigue

Abbreviations: ACGME—Accreditation Council for Graduate Medical Education • OR—odds ratio • CI—confidence interval • AAP—American Academy of Pediatrics

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Accepted Jun 20, 2006.

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