Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception
C. L. Strunk, B. J. Bailey, B. A. Scott, C. W. Cummings, F. E. Lucente, C. W. Beatty, H. B. Neel, H. C. Pillsbury 3rd, D. H. Rice, M. D. Bryan and al. et
Department of Otolaryngology, University of Texas Medical Branch, Galveston 77550-2778.
OBJECTIVE.--To analyze the working environment and work hours of a cohort
of otolaryngology--head and neck surgery residents. DESIGN.--Environmental
analysis questionnaire and a log of daily activities. SETTING.--Residents
were on a clinical rotation system. PARTICIPANTS.--Fifty-nine residents
from six programs, including three public and three private institutions,
from geographically diverse regions of the country were involved in the
study. Residents were equally distributed from their second year through
their fifth year of postgraduate work. All eligible residents participated
in and completed the study. INTERVENTION.--The environmental analysis
survey was designed to elicit resident perception of different aspects of
their working environment. The daily activity log required the resident to
report on activities for each half-hour period for 7 consecutive days.
RESULTS.--Residents were on call an average of 52.8 hours (2.2 days) and
worked 79.4 hours per week. Seventy-five percent believed that the level of
faculty supervision and the degree of resident responsibility was about
right. Two major inefficiencies were the time involved in completion of
paperwork and the lack of nonmedical support services. Thirty-one percent
of the residents responded that fatigue resulted in substandard patient
care 10% of the time. Forty-seven percent responded that their educational
experience was substandard 25% of the time secondary to fatigue. Two thirds
responded that the demands of residency training had a negative impact on
their family and personal life. CONCLUSIONS.--Seventy percent of the
otolaryngology--head and neck surgery residents surveyed at six
institutions believe that an 80-hour workweek, including being on call
every third night with no more than 24 hours of continuous work without
sleep, approximates a reasonable, maximum work schedule. Residents working
the longest hours expressed concern about rendering substandard care and
developing negative attitudes toward patients. Noneducational
inefficiencies were identified and solutions were proposed. Demands of
residency training, even within guidelines established as reasonable, can
have detrimental effects on residents' educational activities and personal
life.
