Objective:

The objective of this study was to compare resident burnout before and after the elimination of 24-hour call shifts for residents within a large academic training program.

Background:

Discussion about resident burnout in recent years has emphasized shift lengths, particularly shifts longer than 24 hours of in-hospital call. Prior data, predominantly in surgical specialties, reports no negative effects on patients and residents reporting improved feelings of continuity and satisfaction with providing care. However, other studies have associated long shifts with negative personal health outcomes including poor sleep, mood disorders, and obesity.

Design/Methods:

Thirty-six senior residents were surveyed over two years. Four different sources of data were collected: 1) Copenhagen Burnout Inventory (CBI), 2) a custom survey generated by the research team, 3) elements of program-wide GME survey data, and 4) elements of program-wide ACGME data. Pre-intervention and post-intervention group data sets were compared using a mixed effects model.

Results:

There was a trend towards overall reduced burnout after the elimination of 24-hour shifts based on custom survey results. This trend was most influenced by residents feeling more well rested at the start of a call shift, safer when returning home, and happy that 24-hour shifts were eliminated. Post-elimination, residents reported spending, on average, 22.5 more minutes in the hospital past the end of their shift time. Two individual items on the CBI showed significance, both showing residents feeling more burnout from interacting with patients on shorter call shifts. Other items tested showed no significant differences.

Conclusions:

Overall, residents appeared to prefer the elimination of 24 hour shifts without any perceived loss in patient safety. There did appear to be some increased burn out around the time spent with patients, which is concerning but could be explained by the longer time required to complete work before the scheduled end of each shift.