Far more serious than the consequences of mandated reductions in resident duty hours outlined by Pattani and colleagues1 is “the trend toward increased failure rates on the oral component of (American) surgical board examinations.” Ahmed and colleagues2 report the failure rates for thoracic surgery tripling and general surgery doubling during the time period that the Accreditation Council for Graduate Medical Education mandated reductions in resident duty hours. They describe how surgical fellows are “inadequately prepared” for the operating room. If they weren’t fellows, these surgeons would be practising in the community.
Surgical residents are doing fewer cases, especially emergency cases, and are less able to recognize and manage complications. The authors1 describe how patient safety may be compromised as these trainees lose valuable experience, but far more worrisome is that they may be incompetent despite completing their residency. This has the potential to be a long-term threat to the wellbeing of the patient population.
The results in Ahmed and colleagues’ 2 paper also question one of the “principles of a pan-Canadian response” to duty hours by describing how the “night float” system is far more disruptive to resident wellbeing than the traditional 24-hour call period. I hope the National Steering Committee on Resident Duty Hours will study this systematic review very closely before making any changes in Canada.
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