Froelich John, Milbrandt Joseph C, Allan D Gordon
Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9679, USA.
J Surg Educ. 2009 Mar-Apr;66(2):85-8. doi: 10.1016/j.jsurg.2008.12.007.
This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period.
Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean +/- standard deviation (SD), and group means were compared using independent t-tests.
No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally.
We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.
本研究探讨每周80小时工作制对骨科住院医师（从PGY-2到PGY-5）所实施手术病例数量的影响。我们还评估了同一时期的骨科住院医师培训考试（OITE）成绩。
数据收集自毕业后医学教育认证委员会（ACGME）的国家数据库，涵盖2003年7月1日之前的3个学年以及之后的5年。比较了实施每周80小时工作制之前3年和之后5年所有住院医师记录的CPT手术程序编码。同时还评估了同一时期每个班级获得的OITE平均原始成绩。数据以均值±标准差（SD）报告，并使用独立t检验比较组均值。
在任何一年的培训中，实行每周80小时工作制之前或之后记录的手术程序编码数量均未发现统计学差异。然而，2003年后PGY-3年记录的CPT编码数量有所增加，接近显著水平（457.7对551.9，p = 0.057）。总体而言，实施工作时间限制后，每位住院医师每年实施的病例平均数量有所增加（464.4例对515.5例）。我们的住院医师或全国范围内，工作时间限制前后的OITE原始成绩均未发现统计学显著差异。
我们发现每个住院医师班级在实施工作时间限制后，所实施病例的平均数量或OITE成绩均无统计学差异，尽管实施工作时间限制后病例总数有所增加。我们还发现全国OITE成绩没有统计学差异。我们的数据表明，每周80小时工作制对这两项住院医师培训指标没有不利影响。
