Background
Methods
Literature Search
Selection of Relevant Manuscripts
Analysis of relevant Papers
Quality of life
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Worsen
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Source
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Basu et al, 2004[14]
A 68-item survey of plastic surgery residents (n = 12)
| Resident quality of life and morale had improved | Gelfand et al, 2004[21]
Pre-post survey of residents (n = 37) and faculty members (n = 27)
| No changes in emotional exhaustion, depersonalisation, and personal accomplishment, no significant changes in residents burnout | _ | _ |
Chung et al, 2004[15]
Pre-post survey of surgical residents.
| Improvements in fatigue-related issues, more work satisfaction, improvement of lifestyle | _ | _ | _ | _ |
Kort et al, 2004[16]
Survey of general surgery residents (n = 164)
| Increased personal time and decreased fatigue at work, more time for family, senior residents were less enthusiastic than junior residents | _ | _ | _ | _ |
Stamp et al, 2005[17]
Pre-post survey of surgical residents (n = 28)
| More time for rest, time with family, and socializing | _ | _ | _ | _ |
Hutter et al, 2006[18]
Survey of surgical residents (n = 58) and surgical attending physicians (N = 58), web based MBI survey(Burnout)
| Decreased burnout scores, less emotional exhaustion, improved quality of life, increased motivation to work | _ | _ | _ | _ |
Immerman et al, 2007[19]
Survey of opinions and attitudes of orthopaedic residents (n = 976) and program directors (n = 85)
| There was an overall agreement that the quality of life had improved | _ | _ | _ | _ |
Schneider et al, 2007[20]
Pre-post evaluation of operative case logs, standardized scores, residents perception survey
| Substantial improvements of residents satisfaction and quality of life | _ | _ | _ | _ |
Education
Education I | |||||
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Improved
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No Change
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Worsen
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Source
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Outcome
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Source
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Outcome
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Source
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Outcome
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Basu et al, 2004[14]
A 68-item survey of plastic surgery residents (n = 12)
| More time for general reading, preparation for operative cases, and for presenta-tions and for conferences | Gelfand et al, 2004[21]
Pre-post survey of residents (n = 37) and faculty members (n = 27), and work-hour regist,
| No significant changes in operating room hours, clinic time, and duration of rounds | Chung et al, 2004[15]
Pre-post survey of surgical residents, determination of program components
| Fewer consultations seen, reduced conference attendance, and reduced operation per week. |
Immerman et al, 2007[19]
Survey of opinions and attitudes of orthopaedic residents (n = 976) and program directors (n = 85)
| Especially junior residents perceived that the new regulation has a positive effect on surgical education | Ferguson et al, 2005[24]
Pre-post study analysing surgical operative logs of residents in general surgery, restrospective review
| The residents operative volume could be maintained, the operative volume was unchanged | Jarman et al, 2004[27]
Pre-post study of general surgery residents, review of operative logs
| Work-hour restrictions result in a significant decrease in operative experience |
Schneider et al, 2007[20]
Pre-post evaluation of operative case logs, standardized scores, residents perception survey
| Substantial increase of operative cases in PGY1 and PGY2, ABSITE Score improved | Malangoni et al, 2005[25]
Pre-post study of work-load and work-hours, senior residents survey at level I trauma center
| The number of operation performed by senior residents did not changed, no difference in trauma patient care exposure or operative case load | Kort et al, 2004[16]
Survey of general surgery residents (n = 164)
| The majority felt that their operative experience was reduced |
_ | _ | Mendoza and Britt, 2005[23]
Mixed-design study of 253 programs, survey of residents, determination of operative volume
| No significant differences in the operative volume of residents | Cohen-Gadol et al, 2005[29]
Nationwide survey of program directors (n = 93) and residents (n = 617)
| 61% of residents noted that the new guidelines have had negative effect on their training |
_ | _ | Spencer and Teitelbaum, 2005[22]
Pre-post study and survey of residents (n = 91) on pediatric surgery
| No significant changes in total number of cases per day for junior and senior residents, residents perception of their education did not changed | Myers et al, 2006[28]
Pre-post survey of general surgery residents (n = 200) at 5 academic medical centers
| Decrease in the evailable opportunities for bedside learning. The quality of education may have declined |
Education II | |||||
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No Change
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Worsen
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Source
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Outcome
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Source
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Outcome
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Source
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Outcome
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_ | _ | Stamp et al, 2005[17]
Pre-post survey of surgical residents (n = 28)
| Residents felt that their training has not been affected significantly | Peabody, 2006[30]
Survey of orthopaedic program directors (n = 94) and senior residents (N = 59)
| The respondents thought that the regulation had a negative impact on orthopaedic residency education |
_ | _ | Hutter et al, 2006[18]
Survey of surgical residents (n = 58) and surgical attending physicians (N = 58), ACGME case logs, ABSITE Score
| Resident training and education objectively were not statisticaly diminisched (ACGME case logs, and ABSITE Score) | _ | _ |
_ | _ | Pappas and Taegue 2007[26]
Pre-post evaluation of case-log database. Single university based orthopaedic residency program
| The new regulation has not decreased the experience of orthopaedic residents | _ | _ |
Patient care
Patient care | |||||
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Improved
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No Change
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Worsen
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Source
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Outcome
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Source
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Outcome
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Source
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Outcome
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Basu et al, 2004[14]
A 68-item survey of plastic surgery residents (n = 12)
| Residents noted an improved ability to deliver patient care, hight consensus that this policy is benefitial for patient care | Rogers et al, 2005[40]
Pre-post study of complications, missed injuries, delayed diagnoses, and admission rates
| No significant difference in the overall complication rate, delayed diagnoses, or missed injuries | Chung et al, 2004[15]
Pre-post survey of surgical resident
| The new regulation reduced continuity of care, reduced consultations seen |
_ | _ | Hutter et al, 2006[18]
Prospective study of mortality, complication rates, NSQIP
| No significan difference in quality of patient care, no differences in mortality rates | Kort et al, 2004[16]
Survey of general surgery residents (n = 164)
| Continuity and safety of care were perceived negatively by surgical residents |
_ | _ |
Schneider et al, 2007
Pre-post evaluation of operative case logs, standardized scores, residents perception survey
| Patient outcome measures, including monthly mortality and number of admissions showed no changes | Cohen-Gadol et al, 2005[29]
Nationwide survey of program directors (n = 93) and residents (n = 617)
| 93% thought that the new reform has had a negative impact on continuity of patient care. |
_ | _ | Shetty et al, 2007[37]
Pre-post study of mortality rates in 551 community hospitals (n = 1.511.945 patients)
| In surgical patients there were no significant changes of mortality rates | Myers et al, 2006[28]
Pre-post survey of general surgery residents (n = 200) at 5 academic medical centers
| Errors related to reduced continuity of care significantly increased. The continuity of care had decreased a lot. |
_ | _ | Volpp et al, 2007[38]
Pre-post study of mortality rates in 3321 nonfederal hospitals (n = 8.529.595 patients)
| The new reform was not associated with either significant worsening or improvements of mortality | _ | _ |
_ | _ | Morrison et al, 2008[39]
Retrospective pre-post study of mortality, length of hospitalisation Data from NTDB
| This analysis demonstrates slightly decreased mortality and morbidity rates. But more likely clinically not important | _ | _ |