Patient Safety and Quality

Work hour limits improve residents' quality of life, but not their satisfaction with their medical education

Mandatory work-hour limitations were imposed in 2003 for medical residents, limiting duty hours to 80 hours per week, 1 day off per week, and no more than 30 consecutive work hours. The work-hour limitations were meant to improve residents' ability to learn and reduce burnout and fatigue that can lead to medical errors. While work-hour limitations do improve residents' quality of life, they do not improve educational satisfaction, according to the University of California, San Francisco (UCSF) researchers who conducted the study.

After system changes were introduced to implement work-hour limitations, researchers, supported by the Agency for Healthcare Research and Quality (HS11416), analyzed survey responses from 125 internal medicine residents at 3 clinical training sites affiliated with UCSF.

The vast majority (78 percent) of residents said reduced work hours had a positive impact on quality of life and hours worked (82 percent). However, 28 percent reported a negative impact on their medical education. Also, 72 percent reported that the amount of time spent doing non-medical-oriented tasks was unchanged. They considered paperwork, answering pages, and scheduling tasks to be the major hindrance to engaging in educational activities.

Residents rated the educational activities—morning report and teaching others—most highly, followed by attending rounds, reading medical literature, and the daily noon conference. After work hour duties were reduced, about two-thirds of residents spent the same time or less time in highly rated educational activities such as teaching others and in conferences. About one-third spent more time reading and teaching others. Educational satisfaction may be more related to the type of workload rather than the number of hours worked, suggest the researchers.

See "Impact of reduced duty hours on residents' educational satisfaction at the University of California, San Francisco," by Arpana R. Vidyarthi, M.D., Patricia P. Katz, Ph.D., Susan D. Wall, M.D., and others in the January 2006 Academic Medicine 81(1), pp. 76-81.

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