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Studying the Effects of ACGME Duty Hours Limits on Resident Satisfaction: Results From VA Learners' Perceptions Survey

Kashner, T. Michael PhD, JD; Henley, Steven S. MS; Golden, Richard M. PhD; Byrne, John M. DO; Keitz, Sheri A. MD, PhD; Cannon, Grant W. MD; Chang, Barbara K. MD, MA; Holland, Gloria J. PhD; Aron, David C. MD; Muchmore, Elaine A. MD; Wicker, Annie; White, Halbert PhD

doi: 10.1097/ACM.0b013e3181e1d7e3
Graduate Medical Education

Background As the Accreditation Council on Graduate Medical Education (ACGME) deliberates over further limiting duty hours of graduate medical education (GME) trainees, few large-scale studies have shown residents to be satisfied with the effect the 2003 standards have had on clinical care, education outcomes, or working environments. This study measures the effect of the 2003 duty hours limits on resident-reported satisfaction with GME training during their rotations through the Department of Veterans Affairs (VA) medical centers from 2001 through 2007.

Method Self-reported satisfaction with clinical care and education environments were assessed by comparing responses to VA's annual Learners' Perceptions Survey administered before 2003 with responses administered after 2003. To measure duty hours effects on satisfaction, before–after differences were adjusted for covariate biases modeled after an exhaustive covariate search with 10-fold cross-validation. Because nonteaching controls are not available in satisfaction studies, we used a robust differencing variable technique to control before–after differences for trend biases in the simultaneous presence of missing data and possible model misspecification.

Results There were 19,605 responders. Adjusting for covariate and trend biases, after the 2003 ACGME standards, 25% more residents in medicine specialties reported satisfaction with VA clinical environment and 11% more with VA preceptors and faculty. For surgery, 33% more residents reported satisfaction with VA clinical environment and 12% more with VA preceptors and faculty. Satisfaction with working environment was mixed.

Conclusions The 2003 ACGME duty hours standards were associated with improved satisfaction for resident clinical training and learning environments.

Dr. Kashner is with the Office of Academic Affiliations, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, and is professor, Department of Medicine, Loma Linda University Medical School, Loma Linda, California, and Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Mr. Henley is president, Martingale Research Corporation, Plano, Texas.

Dr. Golden is professor of cognitive science and engineering, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.

Dr. Byrne is associate chief of staff for education, Jerry L. Pettis Memorial VA Medical Center, Loma Linda VA Healthcare System, Loma Linda, California.

Dr. Keitz is chief of medical service, Miami VA Healthcare System, Miami, Florida, and professor, Department of Medicine, University of Miami, Miami, Florida.

Dr. Cannon is associate chief of staff for academic affiliations, George E. Wahlen VA Medical Center, Salt Lake City, Utah, and Thomas E. and Rebecca D. Jeremy Presidential and Endowed Chair for Arthritis Research, School of Medicine, University of Utah, Salt Lake City, Utah.

Dr. Chang is director of medical and dental education, Office of Academic Affiliations, Veterans Health Administration, Department of Veterans Affairs, Washington, DC.

Dr. Holland is special assistant for policy and planning, Office of Academic Affiliations, Veterans Health Administration, Department of Veterans Affairs, Washington, DC.

Dr. Aron is associate chief of staff for education, VA Senior Scholar, Louis Stokes Cleveland DVA Medical Center, Cleveland, Ohio, and professor of medicine, epidemiology and biostatistics, and organizational behavior, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio.

Dr. Muchmore is associate chief of staff for education, VA Medical Center, San Diego, California, and professor of clinical medicine and vice chair for education, University of California at San Diego School of Medicine, San Diego, California.

Ms. Wicker is data coordinator, Jerry L. Pettis Memorial VA Medical Center, Loma Linda VA Healthcare System, Loma Linda, California.

Dr. White is Chancellor's Associates Distinguished Professor of Economics, Department of Economics, University of California at San Diego, La Jolla, California.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Kashner, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9086; telephone: (214) 648-4608; fax: (214) 648-4612; e-mail: michael.kashner@va.gov.

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© 2010 Association of American Medical Colleges