Resident perspectives on duty hour limits and attributes of their learning environment

BACKGROUND Residents are stakeholders in the debate surrounding duty hour restrictions, yet few studies have assessed their perspective on their programs' efforts to comply with them. OBJECTIVES This paper explores learners' perceptions of the attributes of their programs in relation to duty hour compliance, and looks for evidence whether residents view duty hour limits as important to patient safety. METHODS A grounded-theory framework was used to analyze learners' comments about programs' compliance with US duty hour limits. Data were collected by ACGME in 2011, using resident consensus lists of program strengths and opportunities for improvement generated prior to accreditation site visits. The data set for this analysis encompasses 112 core and 69 subspecialty programs where these lists mentioned duty hours. RESULTS The analysis compared programs where residents viewed duty hour compliance as a strength, and programs where it was identified as an opportunity for improvement. Programs in the first group were characterized by clinical efficiency, responsiveness to problems, and a collegial environment that contributed to residents' ability to meet clinical and learning goals within the restrictions. These attributes were lacking in the second group, and residents also commented on onerous duty hour reporting. Learners did not associate duty hour compliance with patient safety, and the few comments in this area centred almost exclusively on the presence or absence of supervision when junior residents first assumed clinical duties. CONCLUSION The findings have practical implications for programs that wish to enhance their learning and patient care environment, and suggest areas for future research.