Impact of duty hour limits on resident training in otolaryngology.

Hypothesis: Implementation of Accreditation Council for Graduate Medical Education (ACGME) duty hour standards has had limited effects on resident training in otolaryngology.

Study Design: Retrospective survey of residents and residency program directors (PDs).

Methods: Surveys were mailed to residents and PDs in otolaryngology asking about compliance with ACGME duty hour standards and perceptions of changes brought on by the new regulations.

Results: : Surveys were returned by 53.5% of PDs and 29.9% of residents. A majority of PDs described changes made to achieve compliance as "minor;" this consisted most commonly of altering call structure, although some programs hired new support staff or faculty. Mean estimated costs for changes were $14,211. Residents reported working a mean of 67.5 hours per week. Among PDs and residents, only 60% to 70% reported always being in compliance with the main components of the duty hour standards. Residents were largely divided in their opinions as to whether the duty hour limits had led to improvements in patient care, resident education, fatigue, or errors, although most felt that improvement in resident morale had occurred. PDs were more negative because almost half disagreed that improvement had occurred in any of these areas.

Conclusions: Compliance with ACGME duty hour standards remains challenging in otolaryngology. Neither residents nor PDs agree that implementation of the duty hour standards has led to the intended improvements in patient care or resident education, although most agree that resident morale has improved. Further study of objective patient care and educational outcome measures is indicated to validate the need for this change in residency training.