Flexible duty hour policies did not affect general surgery resident performance on examinations during the prospective cluster-randomized FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial.

However, more years under such policies may be required to observe an effect, Eddie Blay Jr., MD , of Northwestern University, Chicago, and his colleagues reported in the Journal of the American College of Surgeons.

Scores on the ABSITE (American Board of Surgery In-Training Examination), Qualifying Exam ( QE ), and Certifying Exam ( CE ) did not differ significantly in either 2015 or 2016 among more than 4,330 general surgery residents who were randomized to a standard duty hour group or a flexible, less-restrictive duty hour group as part of the FIRST trial . For example, mean overall scores on the ABSITE among the 4,363 participants in 2016 were 502.7 and 502.6 in the standard policy and flexible policy groups, respectively. There also were no differences in scores based on individual postgraduate year level, the investigators said ( J Am Coll Surg. 2017;224[2]:137-42 ).

Further, pass rates for the QE were 90.5% and 90.4%, and for the CE were 88.6% and 86.3%, respectively, they noted.

Residents from 117 programs participated in the FIRST trial. Those in the standard policy group had daily duty hour limits as outlined by current Accreditation Council for Graduate Medical Education requirements, with a limit of 16 hours daily for interns and 28 hours for senior residents, and with at least 8 hours between daily shifts and 14 hours off after a 24-hour call. Those in the flexible policy group were exempt from these limits by a formal waiver.

The findings suggest that flexible duty hour policies do not result in significantly different educational outcomes but are limited by concerns about the generalizability of the results, and by a focus on limited aspects of surgeon training and performance, the investigators said.

Measuring actual surgeon education and training quality is challenging and might not be possible with the ABSITE, QE, and CE, they added, noting that future FIRST trial analyses will examine the impact of multiple years of flexible duty hour policies.

The FIRST trial was funded by the American Board of Surgery, the American College of Surgeons, and the ACGME. Stipends for individual authors were supported by a National Institutes of Health grant. The authors reported having no other disclosures.