In 2002, 327 out of 581 residents (56%) completed the survey and 450 out of 625 (72%) in 2004. The distribution of demographics and years in training of the participants were very similar to those of all residents in the same year, respectively (data not shown). Residents were graduates of most of the US allopathic medical schools, a small number of osteopathic medical schools, and a few international medical schools. The majority of residents came from communities outside of Oregon.
In order to evaluate carefully the relationship between duty hours and emotions and attitudes, the entire post intervention cohort was first compared to the entire pre intervention cohort. The first column in Table 1 shows the p-values from the Fisher's exact test for all emotional descriptors. There was no difference in career satisfaction between the groups. Among the 15 emotional descriptors, the post intervention group was significantly more relieved (p = 0.01) and bored (p = 0.04) than the pre intervention group.
The first column in Table 2 displays the p-values from the Fisher's exact test for the 31 positive and negative experiences with the corresponding proportions of "yes" responses. Compared to the pre intervention group, a higher proportion of the post intervention group experienced "feeling more competent about patient care" (p
For further evaluation of the impact of the implementation of the duty hour requirements, residency programs were selected from the post intervention group where duty hour violations had been self-reported. Those post intervention residents were further divided into two groups, self reported violators (PostV, 57 residents) and non-violators (PostNV, 230 residents). A third group was identified (PreM, 205 residents) who represented residents from the pre intervention programs where there was any violation reported in the post intervention survey. Then three groups, PostV, PostNV and PreM were compared to one another. The fourth, fifth and sixth columns in Table 1 show the p-values from the Fisher's exact test for the pairwise comparisons of emotional states for PostV vs. PreM, PostNV vs. PreM, and PostV vs. PostNV, respectively. The post intervention violators (PostV) showed significantly more fatigue compared to both post intervention non-violators (PostNV) and pre intervention matched group (PreM). The main differences in emotional descriptors among the three groups are the negative emotions as one can easily see in Table 1. In summary, the post intervention violators (PostV) reported stronger feelings for numerous negative emotions compared to those of the pre intervention matched group (PreM) and the post intervention non violators (PostNV). In contrast, the post intervention non-violators (PostNV) showed little difference when compared to pre intervention matched group (PreM). The significant differences between the post intervention violators (PostV) and the pre intervention matched residents (PreM) and the post intervention non violators (PostNV) are consistent with the impact of the implementation of 80-hour requirement.
With respect to positive and negative aspects of training experiences among these three groups, all show moderate differences among one another. (See column 4 to 6 in Table 2.) In particular, the post intervention violators (PostV) reported higher levels of negative experiences than the post intervention non violators (PostNV) in 5 of 17 negatives training experience questions, including "meeting the unrealistic expectations of faculty" (p = 0.02), "getting too little sleep" (p = 0.01) and "having to see too many patients in too little time" (p = 0.01).
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