LAUSR

Each time a follow-up study is released regarding the Flexibility in Duty-Hour Requirements for Surgical Trainees Trial (FIRST Trial), I hold my breath as I read the abstract, hoping that this will be the study that considers the effect of duty hours, sleep, and shift length on resident burnout. Unfortunately, I am left disappointed, feeling as if we in surgical education are missing the point somehow. I do not question the intent or conduct of the FIRST trial as some have but rather feel that there remain unanswered questions. Yes, we see that flexible duty hours cause no change in patient outcomes. Yes, we see that residents who participate in flexible duty-hour programs receive better continuity of care with their patients. But what is the effect of the reported decreased time available to spend with family and friends, as well as the decreased time available for extracurricular activities, rest, and health that residents in the flexible arm report? I applaud the efforts of some leading surgeons and medical authorities in bringing recognition of burnout and the need for a focus on wellness, such as highlighted by Balch et al in 2009. A lack of autonomy, difficulty balancing personal and professional life, and high patient volume are sources of stress among attending surgeons and contribute to burnout. As they pointed out, surgeons and physicians may begin to use a coping strategy called “delayed gratification,” where they learn to put their personal lives on hold until after training, after fellowship, after they become an associate professor, and finally after they retire. Are we encouraging this behavior with our insistence that long duty hours are better? I believe that resident satisfaction with their training programs is an important factor that contributes to wellness and decreased burnout. As well, any surgeon who has experienced a negative patient outcome can certainly testify that it can contribute greatly to self-doubt, job dissatisfaction, and stress. Well-trained surgeons and excellent patient outcomes are worthy goals. However, I strongly believe that