PT  - JOURNAL ARTICLE
AU  - Peter E. Wu
AU  - Lynfa Stroud
AU  - Heather McDonald-Blumer
AU  - Brian M. Wong
TI  - Understanding the effect of resident duty hour reform: a qualitative study
AID  - 10.9778/cmajo.20130049
DP  - 2014 Apr 01
TA  - CMAJ Open
PG  - E115--E120
VI  - 2
IP  - 2
4099  - http://www.cmajopen.ca/content/2/2/E115.short
4100  - http://www.cmajopen.ca/content/2/2/E115.full
AB  - Background Concern surrounding the effect of resident fatigue on patient care recently led the National Steering Committee on Resident Duty Hours to publish Canadian recommendations suggesting that duty periods of 24 or more consecutive hours without restorative sleep should be avoided. We sought to characterize how different training programs are preparing for the effect of such changes on education, patient care and provider well-being. Methods Using constructivist grounded theory methodology, we conducted 18 one-on-one semistructured interviews with program directors, division directors and department chiefs from 11 residency programs affiliated with one Canadian medical school. We gathered and analyzed data iteratively until we reached theoretical saturation. Results The key theme articulated by our participants was that changes in resident duty hours would potentially lead to gaps in the provision of clinical care. These changes affect acute care specialties based primarily in the inpatient setting (e.g., medicine, surgery) more than primarily ambulatory (e.g., family medicine) or shift-model based (e.g., emergency) specialties. Potential strategies to address gaps in clinical care include resident-based solutions, faculty-based solutions and solutions based on other providers (e.g., nonacademic physicians, physician extenders). Each solution has unique advantages and disadvantages in terms of education, continuity of care, preparedness for practice and provider well-being. Interpretation Our data-driven framework serves as a guide for programs to anticipate challenges of satisfying clinical care needs in the face of changes to resident duty hours, while balancing education, care continuity, preparedness for practice and provider well-being. Our findings challenge the “one-size-fits-all” approach to changes to resident duty hours and endorse flexibility in enacting duty hour regulations based on specialty-specific factors.