Achieving Accreditation Council for Graduate Medical Education duty hours compliance within advanced surgical training: a simulation-based feasibility assessment

Andrea Obi; Jennifer Chung; Ryan Chen; Wandi Lin; Siyuan Sun; William Pozehl; Amy M Cohn; Mark S Daskin; F Jacob Seagull; Rishindra M Reddy

doi:10.1016/j.amjsurg.2015.03.012

Achieving Accreditation Council for Graduate Medical Education duty hours compliance within advanced surgical training: a simulation-based feasibility assessment

Am J Surg. 2015 Nov;210(5):947-50.e1. doi: 10.1016/j.amjsurg.2015.03.012. Epub 2015 May 15.

Authors

Affiliations

¹ Department of Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: easta@med.umich.edu.
² Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
³ Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Industrial and Operations Engineering, Center for Healthcare Engineering and Patient Safety, Ann Arbor, MI, USA.
⁵ Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.
⁶ Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.

PMID: 26186802
DOI: 10.1016/j.amjsurg.2015.03.012

Abstract

Background: Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience.

Methods: A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule.

Results: For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume.

Conclusions: The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting.

Keywords: Computer simulation; Heart transplantation; Lung transplantation; Medical education; Regulation.

MeSH terms

Computer Simulation
Education, Medical, Graduate / standards*
Feasibility Studies
General Surgery / education
Heart Transplantation / education*
Heart Transplantation / statistics & numerical data
Humans
Internship and Residency
Lung Transplantation / education*
Lung Transplantation / statistics & numerical data
Operative Time
Personnel Staffing and Scheduling / standards*
Personnel Staffing and Scheduling / statistics & numerical data
United States