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Assessing the Effects of the 2003 Resident Duty Hours Reform on Internal Medicine Board Scores

Silber, Jeffrey H. MD, PhD; Romano, Patrick S. MD, MPH; Itani, Kamal M.F. MD; Rosen, Amy K. PhD; Small, Dylan PhD; Lipner, Rebecca S. PhD; Bosk, Charles L. PhD; Wang, Yanli MS; Halenar, Michael J. MPH; Korovaichuk, Sophia; Even-Shoshan, Orit MS; Volpp, Kevin G. MD, PhD

doi: 10.1097/ACM.0000000000000193
Research Reports

Purpose: To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents.

Method: The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform.

Results: The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23), −3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores.

Conclusions: The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations.

Dr. Silber is professor, Departments of Pediatrics and Anesthesiology & Critical Care, Perelman School of Medicine; professor, Department of Health Care Management, The Wharton School; director, Center for Outcomes Research, The Children’s Hospital of Philadelphia; and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Romano is professor of medicine and pediatrics and director, Primary Care Outcomes Research Faculty Development Program, Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California.

Dr. Itani is professor, Department of Surgery, Boston University School of Medicine, and chief of surgery, VA Boston Health Care System and Boston University, Boston, Massachusetts.

Dr. Rosen is professor, Department of Health Policy and Management, Boston University School of Public Health, affiliated with the Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, Massachusetts.

Dr. Small is associate professor, Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Lipner is senior vice president of evaluation, research and development, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Dr. Bosk is professor, Departments of Sociology and Medical Ethics & Health Policy, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

Ms. Wang is a statistical programmer, Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.

Mr. Halenar is a research assistant, Center for Health Equity Research and Promotion, Veteran’s Administration Hospital, Philadelphia, Pennsylvania.

Ms. Korovaichuk is a research assistant, Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.

Ms. Even-Shoshan is associate director, Center for Outcomes Research, The Children’s Hospital of Philadelphia, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Volpp is professor, Department of Health Care Management, The Wharton School, and Department of Medicine, Perelman School of Medicine; and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania; and affiliated with the Center for Health Equity Research and Promotion, Veterans Administration Hospital, Philadelphia, Pennsylvania.

Funding/Support: This research was supported by a grant from the National Heart, Lung, and Blood Institute, Grant # R01 HL082637.

Other disclosures: None reported.

Ethical approval: This research protocol was reviewed and approved by the institutional review boards of The Children’s Hospital of Philadelphia and the University of Pennsylvania.

Previous presentations: Portions of this research were presented at the Academy Health Annual Meeting, June 2012, Orlando, Florida.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A190.

Correspondence should be addressed to Dr. Silber, Center for Outcomes Research, The Children’s Hospital of Philadelphia, 3535 Market St., Suite 1029, Philadelphia, PA 19104; telephone: (215) 590-5635; e-mail: silberj@wharton.upenn.edu.

© 2014 by the Association of American Medical Colleges