Association of the 2003 and 2011 ACGME Resident Duty Hour Reforms With Internal Medicine Initial Certification Examination Performance

摘要

The Accreditation Council for Graduate Medical Education (ACGME) introduced duty hour reforms for resident physicians in 2003, which included the current 80-hour maximum work week, averaged over 4 weeks; subsequent 2011 work hour reforms included policies limiting maximum shift lengths for intern physicians.~(~(1)) Both reforms stemmed from a growing concern about the effects of resident fatigue on both patient safety and resident well-being.~(~(1),~(2)) There has been much debate surrounding these reforms, and opponents have argued that they have negatively affected resident education.~(~(2),~(3)) After assessing these concerns and the findings from a recent study of flexible models of resident education, the ACGME approved new 2017 work hour standards.~(~(2),~(4))However, there remains a lack of data on the actual impact of work hour reforms. Previous studies have evaluated surgical resident certification examination scores as a proxy for quality of resident education in the context of duty hour reforms.~(~(3)) We analyzed first-time taker pass rates for the American Board of Internal Medicine (ABIM) initial certification examination, a standardized examination independent from the ACGME, to evaluate whether 2003 or 2011 ACGME duty hour reforms were associated with differences in internal medicine (IM) resident pass rates on a national certification examination.~(~(5)).