Orthopedic residency: are duty hours predictive of performance?
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OBJECTIVE: This study examines the relationship between self-recorded resident work hours and Orthopedic In-training Examination (OITE) scores, resident clinical performance, and American Board of Orthopedic Surgery pass rates. The hypothesis of this study is that increasing duty hours would have a positive correlation with clinical and OITE performance. DESIGN: Total duty hours and recorded operating room hours from a single orthopedic residency program were extracted from 2006 to 2012. During the same time span, OITE scores, resident clinical scores from the E-Valuation system, and American Board of Orthopedic Surgery pass rates were collected. The correlation between the variables was assessed using the Pearson correlation coefficient's precision statistic. SETTING: A large public tertiary academic center in the upper Midwestern United States. PARTICIPANTS: A total of 82 orthopedic surgery residents over 7 years. RESULTS: A total of 82 residents were matriculated between 2006 and 2012. The average weekly recorded duty hours were as follows: postgraduate year 2 (PGY2) = 60 hours/week (Standard Deviation (SD) +/- 4), PGY3 = 59 hours/week (SD +/- 5), PGY4 = 51 hours/week (SD +/- 4), PGY5 = 49 hours/week (SD +/- 3). There was significant variability in the average number of hours worked among residents (range: 2128-3753h/y) for the full academic year. The OITE scores and the work hours were found to be independent of each other (rho = 0.017, p = 0.825), and no correlation was found between OITE scores and the resident E-value scores (rho = 0.071, p = 0.34). Residents spent 36% to 48% of their time in the operating room. Second year residents logging more hours scored higher on faculty evaluation of overall competency (rho = 0.31, p = 0.035). Faculty assessment of technical skills had a positive correlation with operating room duty hours for PGY5 class (rho = 0.346, p = 0.025). CONCLUSIONS: A large variation in duty hours exists between resident-logged duty hours. No correlation exists between in-training scores and duty hours. There is a positive correlation between senior resident operating room hours and technical skill scores.
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