The 2011 ACGME resident physician duty hour changes shortened the number of consecutive hours interns could work and mandated more time off between shifts. The FIRST trial randomly assigned general surgery residency programs to the standard duty hour policy or to a more flexible duty hour policy. After one year, the trial demonstrated no difference in patient outcomes, but did show that residents assigned to the more flexible schedule were more likely to perceive a negative impact of duty hours on wellbeing. In this follow-up survey study of surgery residents after year 2 of the trial, researchers found that negative perceptions of wellbeing remained higher among those exposed to the flexible duty hour policy, but concerns about wellbeing had decreased.