As we chart new waters

Pamela Lipsett

As our new class of residents enters the Halsted General Surgery Training Program, we face a time of unprecedented change in both the regulatory environment of training and in our health care delivery systems. The new duty-hour regulations principally change PGY-I training and will fundamentally alter new residents’ exposure to independent patient care experiences, especially when they might be experiencing personal fatigue.

These regulations have come about supported by strong political forces justifying these limitations based on sleep deprivation studies, but with little data supporting a beneficial effect on patient care or resident education. In fact, because of the length of surgical training, especially in academic surgery training programs, we have little understanding of the effects of the 2003 work-hour changes on resident education. We do know that despite stated goals of improving patient care, there is little evidence that patient care has been fundamentally changed by the current work-hour regulations.

A recent systematic review suggests that the effect of the 2003 restrictions on surgical training were either generally positive or neutral on resident education and lifestyle. However, the effects on the surgical faculty were considered to be negative. Because the new rules recognize differences in responsibility by the level of resident training, they are likely to impact residents at different levels in different ways. As faculty, we must assure our new residents that they will be well-trained, even though this will not be in the manner Halsted brought to us more than 100 years ago.

We must remain positive and supportive of these changes. We must emphasize the importance of performing in teams with shared responsibilities of patient care with a variety of providers. We must ensure that residents understand the moral commitment to patient care without prioritizing self-interests. The duty to care requires us to provide the highest standards of care, creating a tension between the duty to care for patients and the importance of self-care and understanding our own limitations. We must ensure that our residents continue to understand this delicate balance.

The new regulations create new supervisory requirements and recognition of sleep deprivation in ourselves and others. Because these regulations will alter so many aspects of surgical training, we have an opportunity to approach this time in a scholarly manner to understand the positive and perhaps the unintended consequences not only on patient care, but on the Halsted Residency Program. We expect our residents and faculty to approach these changes with the typical vigor and rigor that have characterized the Halsted Residency. Halsted brought an organized system of surgical training to this country, and now it is time for us to chart the path forward into unknown waters, knowing that in the end our patients will receive the best care and our residents will be among the best-trained in the world.