Do restricted hours decrease residents' technical experience?

The imposition of work-hour restrictions on residents in 2003 has not materially decreased ob/gyn residents' experience in obstetric and gynecologic procedures, according to a study conducted by researchers at the University of Missouri-Kansas City. The study compared objective national data from 3 years before the rules were implemented with data for the 3-year period beginning 4 years after the work-hour rules went into effect. In addition, changes in national practice during the same time period were compared.

Changes in resident experience in core obstetric procedures not only have paralleled those occurring nationwide during the past decade, but also have had little overall effect on total experience. Specifically, before hours were restricted, residents had an average median total case experience of 513 in core ob/gyn procedures in the role of surgeon compared with 510 after the restrictions were instituted.

In keeping with national trends, resident operative vaginal deliveries decreased over time, from a median of 42 to 26 after restrictions were instituted, and cesarean deliveries increased, from 166 to 221. Resident experience with abdominal hysterectomy decreased (from 83.7 to 75.4 cases), and experience with vaginal hysterectomy remained steady at 31.3 cases compared with 34.6 cases. In contrast, resident experience with laparotomy (41.7 vs 54.6 cases), laparoscopy (56.7 vs 94 cases), and hysteroscopy (39.7 vs 62.7 cases) has increased since imposition of work-hour rules.