Study data published in JAMA Surgery indicate that surgical residents exceeding the duty hour limits do so voluntarily and not as a product of coercion from attending surgeons or senior residents.

The study included residents in the flexible arm of the Flexibility in Duty Hour Requirement for Surgical Trainees trial (FIRST; identifier: NCT02050789). Per 2017 legislation passed by the Accreditation Council for Graduate Medical Education, residents in the flexible group were permitted to stay after a 24-hour call only if by choice. If residents in this arm exceeded hour requirements for a typical month, they were asked questions about hour expectations or coercion. Researchers developed logistic regression models to capture the various factors contributing to residents exceeding duty hours.

A total of 1838 general surgery residents (59.8% men) responded to the survey. Among respondents, 68.4% exceeded the duty hour requirements. Of those who exceeded the requirements, 21.7% reported that their programs expected them to stay longer, 26.6% reported that their attending surgeons expected them to stay longer, and 21.1% reported that their senior residents expected them to stay longer. Overall, 78.1% responded that they voluntarily stayed longer, and 7.4% reported coercion from attending surgeons and 9.3% reported coercion from senior residents. Women (odds ratio [OR], 1.89; 95% CI, 1.52-2.34) and junior residents in their second (OR, 4.47; 95% CI, 3.32-6.03) or third (OR, 1.43; 95% CI, 1.14-1.81) postgraduate years were most likely to report exceeding the duty hour requirements. However, researchers found no significant associations between resident or program characteristics and coercion by attending surgeons and senior residents.

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Researchers noted the bias inherent in self-reported data but emphasized that the anonymous nature of the surveys would encourage participants to answer honestly. Although most hour flexibility was used voluntarily, resident programs should remain vigilant in preventing coercion from senior personnel.


Blay E Jr., Englehardt KE, Hewitt DB, Dahlke AR, Yang AD, Bilimoria KY. Evaluation of reasons why surgical residents exceeded 2011 duty hour requirements when offered flexibility: a FIRST trial analysis [published online June 13, 2018]. JAMA Surg. doi:10.1001/jamasurg.2018.1047