Other consequences of reduced duty hours
========================================

* Reena Pattani
* Peter E. Wu
* Irfan A. Dhalla

As we noted in our paper,1 reduced duty hours may negatively affect the development of competence, which could have an impact on patient safety. This is particularly relevant for procedure-intensive specialties, where increasing evidence suggests that work-hour reforms have deleterious effects on educational outcomes,2–5 including worse scores on licensing examinations. 6 The review by Ahmed and colleagues, 7 which was published after our paper, came to similar conclusions.

We agree with Dr. Allen8 that it will be important for the educational community to consider these findings and others as they evaluate duty-hour reforms.

## References

1.  Pattani R, Wu PE, Dhalla IA. Resident duty hours in Canada: past, present and future. CMAJ 2014;186:761–5.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTg2LzEwLzc2MSI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xODcvMy8yMDcuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Poulose BK, Ray WA, Arbogast PG, et al. Resident work hour limits and patient safety. Ann Surg 2005;241:847–56.
    
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3.  Hoh BL, Neal D, Kleinhenz D, et al. Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107,000 neurosurgical trauma patients in the Nationwide Inpatient Sample database. Neurosurgery 2012;70:1369–81.
    
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4.  Gopaldas RR, Chu D, Dao T, et al. Impact of ACGME work-hour restrictions on the outcomes of coronary artery bypass grafting in a cohort of 600,000 patients. J Surg Res 2010;163:201–9.
    
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5.  Breen KJ, Hogan A, Mealy K. The detrimental impact of the implementation of the European working time directive (EWTD) on surgical senior house officer (SHO) operative experience. Ir J Med Sci 2013;182:383–7.
    
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6.  Jagannathan J, Vates G, Pouratian N, et al. Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity. J Neurosurg 2009;110:820–7.
    
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7.  Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: Impact on resident wellness, training, and patient outcomes. Ann Surg 2014;259:1041–53.
    
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8.  Allan GC. Other consequences of reduced duty hours [letter]. CMAJ 2014;187:207.