Sleep, supervision, education, and service: views of junior and senior residents

Abstract

Objectives: To assess sleep time and views about faculty supervision and educational activities of residents training only under 2003 duty hours standards.

Design: A survey was delivered with the 2010 American Board of Surgery In-Training Examination (ABSITE). Twelve items explored sleep patterns, supervision, and educational activity times. Survey response relationships to gender, resident level, and program variables were explored through factorial analysis of variance and effect size testing. Alpha was set to <0.001, and effect size (omega-squared) significance was set at ≥1% of variance explained to limit statistically significant but practically unimportant results. Survey participation was voluntary, and responses were processed separately from ABSITE scoring.

Setting: General surgery residencies.

Participants: A total of 6161 categorical surgery residents: 2545 first postgraduate year (PGY1) and second postgraduate year (PGY2) trainees took the junior examination (IJE), and 3616 third postgraduate year (PGY3) and above residents took the senior examination (ISE).

Results: Response rates were ≥95%. Sleep during extended call was significantly less for IJE residents, but IJE residents' sleep mirrored ISE residents' sleep on night float, day assignments, and days off. Faculty supervision was judged Adequate or better by more than 90% of both groups. IJE residents significantly more often rated operative caseloads and operating time as inadequate; caseloads and operating room (OR) time also linked significantly to program type. IJE residents reported significantly higher inpatient, but not outpatient, time. Most IJE and ISE residents agreed that care continuity opportunities were Adequate and judged workloads as Adequate or better. Although many IJE and ISE residents rated educational time as Adequate or better, 25% of each group scored it as Insufficient or worse.

Conclusions: Resident discretionary time is not devoted primarily to sleep. Residents consider increased faculty supervision unnecessary. IJE residents believe their time could be better apportioned across educational settings. Decreased workloads and increased educational time are desired by substantial minorities of IJE and ISE residents, arguing for further interventions to preserve education over service.