Flexible duty hour policies did not affect general surgery resident performance on examinations during the prospective cluster-randomized FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial.
However, more years under such policies may be required to observe an effect, Eddie Blay Jr., MD, of Northwestern University, Chicago, and his colleagues reported in the Journal of the American College of Surgeons.
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Further, pass rates for the QE were 90.5% and 90.4%, and for the CE were 88.6% and 86.3%, respectively, they noted.
Residents from 117 programs participated in the FIRST trial. Those in the standard policy group had daily duty hour limits as outlined by current Accreditation Council for Graduate Medical Education requirements, with a limit of 16 hours daily for interns and 28 hours for senior residents, and with at least 8 hours between daily shifts and 14 hours off after a 24-hour call. Those in the flexible policy group were exempt from these limits by a formal waiver.
The findings suggest that flexible duty hour policies do not result in significantly different educational outcomes but are limited by concerns about the generalizability of the results, and by a focus on limited aspects of surgeon training and performance, the investigators said.
Measuring actual surgeon education and training quality is challenging and might not be possible with the ABSITE, QE, and CE, they added, noting that future FIRST trial analyses will examine the impact of multiple years of flexible duty hour policies.
The FIRST trial was funded by the American Board of Surgery, the American College of Surgeons, and the ACGME. Stipends for individual authors were supported by a National Institutes of Health grant. The authors reported having no other disclosures.