The Journal of Bone and Joint Surgery (American). 2008;90:924-927.
doi:10.2106/JBJS.G.00918
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Operative Experience in an Orthopaedic Surgery Residency Program: The Effect of Work-Hour Restrictions

Michael A. Baskies, MD1, David E. Ruchelsman, MD2, Craig M. Capeci, MD2, Joseph D. Zuckerman, MD2 and Kenneth A. Egol, MD2

1 Orthopaedic Surgery Hand Service, Massachusetts General Hospital, 55 Fruit Street, YAW 2100, Boston, MA 02114. E-mail address: baskiesm{at}hotmail.com
2 Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for D.E. Ruchelsman: der231{at}med.nyu.edu. E-mail address for C.M. Capeci: cmc352{at}med.nyu.edu. E-mail address for J.D. Zuckerman: Joseph.Zuckerman{at}nyumc.org. E-mail address for K.A. Egol: egolk01{at}nyumc.org

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 implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting.

Methods: We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions.

Results: Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02).

Conclusions: On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded.


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Letters to the Editor:

Read all Letters to the Editor

Orthopaedic training exposure can be maintained despite falling hours.
Joel TK Melton, et al.
JBJS Online, 11 Jul 2008 [Full text]
Dr. Egol et al. respond to Drs. Melton and Goodwin
Kenneth A, Egol, et al.
JBJS Online, 21 Jul 2008 [Full text]