Thank you for the comments and discussion so far. Let’s talk about continuity of care. The authors noted, and Dr. de Virgilio and Dr. Jamal have reinforced, that a key aspect of training is the ability to follow a patient from initial work-up, to the OR, to postoperative care. The authors found that residents in flexible policy programs were significantly less likely to report leaving/missing an operation or handing off active patient issues. The effect sizes were meaningful, with odds about half those of residents with standard hours.
Are these interruptions happening more to interns, junior residents, or senior residents? The current ACGME duty hour requirements are most restrictive for interns, as Dr. Bryczkowski pointed out. Are the current requirements impacting a specific PGY more than others? Is greater flexibility required at a certain point in residency, or across the board? Some interruptions to continuity are unavoidable; the flexible policy group had non-zero odds of these events. Beyond duty hour management, what can be done to improve clinical and educational continuity?