Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study

Surgery. 2005 Aug;138(2):150-7. doi: 10.1016/j.surg.2005.05.011.


Background: The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our published data from the preceding year indicated significant impairment in psychologic well-being among surgery residents. The purpose of this study was to determine whether psychologic well-being and academic performance of surgery residents improved after inception of the 80-hour workweek.

Methods: A single-blinded survey of general surgery residents (n=130) across 4 US training programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom Checklist-90-R and Perceived Stress Scale) and the American Board of Surgery In-Training Examination; comparison was done with preceding year and societal data. Primary outcomes were "psychologic distress" and "perceived stress." Secondary outcomes were "somatization," "depression," "anxiety," "interpersonal sensitivity," "hostility," "obsessive-compulsive behavior," "phobic anxiety," "paranoid ideation," "psychoticism." and "academic performance." The impact of demographic variables was assessed.

Results: Mean psychologic distress improved from the preceding year (P < .01) but remained elevated, compared with societal norms (P < .001). The proportion of residents meeting the criteria for clinical psychologic distress (>or=90th percentile) decreased from 38% before, to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P < .0001) without improvement from the preceding year. Overall academic performance was unchanged. Previously elevated secondary psychologic outcomes improved after July 2003 (P < .05), although obsessive-compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to normalize. Male gender and single status were independent risk factors for psychologic distress.

Conclusions: Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents. The perception of stress and academic performance remains unchanged.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affective Symptoms / prevention & control
  • Affective Symptoms / psychology
  • Attitude of Health Personnel
  • Burnout, Professional / prevention & control
  • Burnout, Professional / psychology*
  • Education, Medical, Graduate / organization & administration
  • Female
  • General Surgery / education*
  • Humans
  • Internship and Residency / organization & administration*
  • Male
  • Medical Staff, Hospital / organization & administration
  • Medical Staff, Hospital / psychology*
  • Personnel Staffing and Scheduling*
  • Work Schedule Tolerance / psychology*