The Journal of Bone and Joint Surgery (American). 2007;89:904-909.
doi:10.2106/JBJS.F.01083
© 2007 The Journal of Bone and Joint Surgery, Inc.
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The Impact of the Accreditation Council for Graduate Medical Education Work-Hour Regulations on the Surgical Experience of Orthopaedic Surgery Residents

Alexander J. Pappas, MD1 and David C. Teague, MD1

1 Department of Orthopedic Surgery and Rehabilitation, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Room WP1380, Oklahoma City, OK 73117-1026. E-mail address for A.J. Pappas: Alexander-Pappas{at}ouhsc.edu. E-mail address for D.C. Teague: David-Teague{at}ouhsc.edu

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The advent of the eighty-hour workweek regulations generated a great deal of controversy over the potential loss of operative experience for general surgery and surgical specialty residents. We believed an investigation to review the operative experience of orthopaedic surgery residents before and after the adoption of the Accreditation Council for Graduate Medical Education duty-hour guidelines would provide important information in this debate.

Methods: The total number of surgical Current Procedural Terminology codes logged in the case-log database of the Accreditation Council for Graduate Medical Education by each second through fifth year orthopaedic resident at a single university-based program was collected from July 1, 2001, to June 30, 2005. Two groups were created from the data obtained. Group I (thirty-nine residents) included surgical codes logged for the two years prior to the implementation of the eighty-hour workweek (July 1, 2003), while Group II (forty residents) included the codes for the following two years. The average number of codes was determined for Group I and Group II. The two groups were then subdivided by postgraduate year of training. The average number of surgical codes per training year was calculated. Then the second and third year (junior) resident and fourth and fifth year (senior) resident groups were combined to create two subgroups. The mean number of surgical codes was determined for each group, and the groups were compared.

Results: The surgical case logs of thirty-five orthopaedic residents were reviewed during the study period. One resident left the program during the first year of the study and was excluded because of incomplete data. A total of 36,464 surgical codes were logged. The average yearly number of surgical codes per resident was 461.4. The average total number of coded procedures per resident before and after the start of the eighty-hour workweek were 455.4 and 467.3, respectively. The average yearly number of surgical codes was 432.5 for the junior residents and 491.1 for the senior residents. The average number of codes logged before and after the start of the eighty-hour workweek were 407.3 and 455.3, respectively, for the junior residents compared with 501.2 and 480.6 for the senior residents. No significant differences between the groups in any category were identified.

Conclusion: Although many aspects of surgical training may be affected by the new work-hour restrictions, our review of the operative experience of orthopaedic surgery residents at a single institution demonstrated no significant differences before and after the implementation of the eighty-hour workweek.


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M. A. Baskies, D. E. Ruchelsman, C. M. Capeci, J. D. Zuckerman, and K. A. Egol
Operative Experience in an Orthopaedic Surgery Residency Program: The Effect of Work-Hour Restrictions
J. Bone Joint Surg. Am., April 1, 2008; 90(4): 924 - 927.
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