16-Hour Work Limit for Medical Interns Associated With Decreased Operative Experience, Study Suggests

The 16-hour work limit for interns, implemented in July 2011, is associated with a decrease in intern operative experience, according to a study by Samuel I. Schwartz, M.D., of the Harbor-University of California at Los Angeles Medical Center, Torrance, and colleagues.

A total of 249 general surgery interns from 10 general surgery residency programs in the western United States participated in the study. Interns from the class with the 16-hour work limit (N=52) were compared to others from the four preceding years without the 16-hour work limit (2007-2010; N=197).

As compared with the preceding four years, the 2011-2012 interns recorded a 25.8 percent decrease in total operative cases (65.9 vs 88.8 cases), a 31.8 percent decrease in major cases (54.9 vs. 80.5 cases), and a 46.3 percent decrease in first-assistant cases (11.1 vs 20.7 cases). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern group whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver and pancreas cases.

“If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume,” the authors conclude.

(JAMA Surgery. Published online July 10, 2013. doi:10.1001/jamasurg.2013.2677.