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FIRST Trial: Patients Not Harmed When Surgical Residents Work Flexible Hours

FIRST Trial: Patients Not Harmed When Surgical Residents Work Flexible Hours

Patients had no greater risk of death or serious morbidity when cared for by surgical residents working flexible duty hours when compared to those working standard Accreditation Council for Graduate Medical Education-mandated hours. Both resident groups were equally satisfied with the quality of their education and their personal well-being. Residents in the flexible work hours cohort were significantly less inclined to feel that duty hours policies had a negative effect on patient safety, continuity of care, professionalism, or resident education. However, the flexible group residents were significantly less satisfied with the amount of time they had to rest. These results were from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, which was presented this morning at the Academic Surgical Congress in Jacksonville, Florida and published ahead of print in the New England Journal of Medicine today. The authors randomized 59 general surgery programs and their 71 affiliated hospitals to the standard rigid 80-hour work week schedule and 58 programs having 80 affiliated hospitals to an 80-hour work week with flexible hours. In order for the study to be done, the ACGME waived its four rules regarding maximum shift length and minimum hours off duty between shifts. “The issue has been hotly debated, but prior to the FIRST Trial, limited data existed…”   Outcomes for the 138,691 patients in the trial were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database during the year of the study—July 1, 2014 to June 30, 2015. The response rate for the 4330 residents surveyed about their experiences with the two work hours policies ranged...
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