Psychologic well-being of surgery residents after inception of the 80-hour workweek:: A multi-institutional study

Background. The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our published data from the preceding year indicated significant impairment in psychologic well-being among surgery residents. The purpose of this study was to determine whether psychologic well-being and academic performance of surgery residents improved after inception of the 80-hour workweek. Methods. A single-blinded survey of general surgery residents (n = 130) across 4 US training Programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom Checklist-90-R and Perceived Stress Scale) and the American Board, of Surgery In.-Training Examination; comparison was done with preceding year and societal data. Primary outcomes were 'Psychologic distress and 'perceived stress. Secondary outcomes were somatization, depression, anxiety, interpersonal sensitivity, hostility, obsessive compulsive behavior, phobic anxiety, paranoid ideation, psychoticism. and academic performance. The impact of demographic variables was assessed. Results. Mean psychologic distress improved from the preceding year (P <. 01) but remained elevated, compared with societal norms (P <.001). The proportion of residents meeting the criteria for clinical psychologic distress (>= 90th percentile) decreased from 38% before, to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P <. 0001) without improvement from the preceding year. Overall academic performance was unchanged. Previously elevated secondary psychologic outcomes improved after July 2003 (P <.05), although obsessive compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to normalize. Male gender and single status were independent risk factors for psychologic distress. Conclusions. Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents. The perception of stress and academic performance remains unchanged.