Elsevier

Journal of Surgical Education

Volume 71, Issue 5, September–October 2014, Pages 707-715
Journal of Surgical Education

Original Reports
Perceived Effects of the 16-Hour Workday Restriction on Surgical Specialties: Quebec’s Experience

https://doi.org/10.1016/j.jsurg.2014.01.008Get rights and content

Objective

Quebec was the first Canadian province to implement a 16-hour workday restriction. Our aim was to assess and compare Quebec’s surgical residents’ and professors’ perception regarding the effects on the educational environment, quality of care, and quality of life.

Design

The Surgical Theater Educational Environment Measure, the Postgraduate Hospital Educational Environment Measure, quality of the medical act, and quality-of-life questionnaires were administered 6 months after the work-hour restrictions.

Setting

Université de Montréal Surgery Department, Montréal, Québec, Canada; Université de Sherbrooke Surgery Department, Sherbrooke, Québec, Canada; Université Laval Surgery Department, Québec, Québec, Canada; and McGill University Surgery Department, Montréal, Québec, Canada.

Participants

Surgical residents and professors of all specialties within the 4 university surgery departments in Quebec through a voluntary web-based survey.

Results

A total of 280 questionnaires were analyzed with response rates of 29.7% and 16.4% for residents and professors, respectively. Data were coded on a scale from 2 (strong improvement perception) to −2 (strong deterioration perception). The professors perceived a higher negative effect than the residents did on the educational environment, i.e., role of autonomy (−0.399 vs −0.577, p < 0.001), teaching (−0.496 vs −0.540, p < 0.001), social support (−0.345 vs −0.535, p < 0.001), and surgical learning (−0.409 vs −0.626, p < 0.001). The professors also observed a higher negative effect on patients’ safety (−0.199 vs −0.595, p = 0.003) and quality of care (−0.077 vs −0.421, p = 0.014). The latter was even perceived as unchanged by residents (−0.077, 95% CI: −0.249 to 0.095). The residents perceived a negative effect on their quality of life, whereas the professors believed the contrary (0.500 vs −0.496, p < 0.001). More professors than residents believed residency should be prolonged (80.8% vs 50.6%, p < 0.001).

Conclusions

Residents and professors perceive a mild negative effect on the educational environment and quality of care, whereas their perception on quality of life is opposite. The professors seem concerned about adequate training to the point of considering increasing training length.

Section snippets

Methods

This survey-based study was approved by our institution’s ethic committee. We constructed an online survey consisting of 19 multiple-choice questions, of which 10 were based on a Likert-type scale. The questionnaire was designed to assess the perception of the effects of the new duty-hour restrictions on the educational environment, quality of care, and quality of life. For the first item, the Surgical Theater Educational Environment Measure20 and the Postgraduate Hospital Educational

Analysis

Only surveys that were 100% completed were analyzed. As a mention, McGill University sent our survey to both surgical and nonsurgical programs. Nonsurgical respondents were identified through those who had stated their specialty as other, a category for which specifying the exact field of practice was mandatory. Questionnaires from nonsurgical specialties were excluded and deleted from this study. All data collection and statistical analyses were performed using R Core Team 2012 (R: A language

Study Demographics

A total of 153 residents and 127 professors completed the survey. Demographics of survey respondents including sex, residency level, years of teaching, surgical specialty, university, on-call system worked in, and knowledge of the new regulations are shown in Table 2.

Most residents who responded were male and junior residents (postgraduate years 1-2). Most were related to general surgery (46%) and orthopedics (20%). Overall, 24.8% of the residents were from McGill University, 18% were from

Discussion

This survey demonstrates concern among surgical residents and professors that the quality of education might be compromised by the new duty-hour regulations. All areas pertaining to the educational environment were felt to be negatively affected by the restrictions. This finding is even more pronounced among professors, which is important with regard to their knowledge on the educational experience that residents need for a comprehensive training. Conversely, residents base their perception on

Conclusion

This survey-based study indicates that residents and professors perceive a mild negative effect on the educational environment and quality of care 6 months following the implementation of new restrictions. However, overall, the effect on quality of life is perceived as negative with the new restrictions. Professors seem concerned about adequate training to the point of considering increasing training length. Further evaluation is needed to compare on a longitudinal basis these perceptions. In

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