Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Protocol: A National Cluster-Randomized Trial of Resident Duty Hour Policies.

Importance: Debate continues regarding whether to further restrict resident duty hour policies, but little high-level evidence is available to guide policy changes.

Objective: To inform decision making regarding duty hour policies, the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial is being conducted to evaluate whether changing resident duty hour policies to permit greater flexibility in work hours affects patient postoperative outcomes, resident education, and resident well-being.

Design, Setting, And Participants: Pragmatic noninferiority cluster-randomized trial of general surgery residency programs with 2 study arms.