Of duty hour violations and shift work: changing the educational paradigm

• Evaluate the impact of the new ACGME duty hour restrictions and violations.
• Implement and evaluate night shift surgical education and duty hour violations.
• Determine feasibility and sustainability of a night shift system.
• Night shift improved duty hour violations, didactic time and operative cases.

BackgroundSuccessful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education.MethodsA system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system.ResultsSurvey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%.ConclusionsNight shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time.