Effects of a twenty-four hour call period on resident performance during simulated endoscopic sinus surgery in an Accreditation Council for Graduate Medical Education-compliant training program

Objectives/Hypothesis: Since the early 1990s, extended resident work hours have undergone increasing scrutiny. Although previous studies have demonstrated conflicting results regarding cognitive decline secondary to fatigue, few studies have specifically examined the effects of fatigue on surgical performance. No previous studies have examined resident performance under current Accreditation Council for Graduate Medical Education (ACGME) work-hour guidelines that limit residents to an average number of work hours of 80 hours per week. The study sought to determine whether an endoscopic sinus surgery simulator (ES3) measured performance changes before and after a 24-hour on-cal period in residents following mandated work-hour limitations. Study Design: Case control, crossover trial at a Level I trauma center. Methods: Eight general surgical residents were trained on the novice mode of the ES3. These residents were then tested twice both before and after on-call duties. Performance and hazard scores were compared using a paired t test. Results: No statistically significant change in the number of errors, time to task completion, or overall performance was identified in the study between the precall and postcall groups. There was a trend toward improved speed at the expense of accuracy in the postcall group. Postcall score between the two trials improved, on average, by 3.3 (P = .045). Conclusion: In the study of residents following current ACGME work-hour mandates, there was no diminution in performance before and after a 24-hour on-call period. There was a trend toward improved speed at the expense of accuracy. Furthermore, repetition on the ES3 in the postcall period can result in improved ES3 proficiency.