@article{6933,
  author = {Kathlyn E. Fletcher and Darcy A. Reed and Vineet Arora},
  title = {Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules.},
  abstract = {<p><b>CONTEXT: </b>The ACGME-released revisions to the 2003 duty hour standards.</p><p><b>OBJECTIVE: </b>To review the impact of the 2003 duty hour reform as it pertains to resident and patient outcomes.</p><p><b>DATA SOURCES: </b>Medline (1989-May 2010), Embase (1989-June 2010), bibliographies, pertinent reviews, and meeting abstracts.</p><p><b>STUDY SELECTION: </b>We included studies examining the relationship between the pre- and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies.</p><p><b>DATA EXTRACTION: </b>One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality.</p><p><b>RESULTS: </b>Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Meta-analysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I(2) 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies.</p><p><b>LIMITATIONS: </b>Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible.</p><p><b>CONCLUSIONS: </b>Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.</p>},
  year = {2011},
  journal = {J Gen Intern Med},
  volume = {26},
  pages = {907-919},
  month = {08/2011},
  issn = {1525-1497},
  doi = {10.1007/s11606-011-1657-1},
  language = {eng},
}