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Surgery training program at Mass. General off probation; residents working fewer hours

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February 16, 2012|By Liz Kowalczyk

The surgery training program at Massachusetts General Hospital, one of the oldest and most competitive apprenticeships for young doctors, has started 2012 with a clean slate after being on probation for two years.

The Accreditation Council for Graduate Medical Education notified Dr. John Mullen, cq the surgical residency director, late last year that the program is no longer on probation and reaccredited it for five years.

In its letter, the organization “commended the program for its demonstrated substantial compliance’’ with ACGME requirements, which include limits on residents’ working hours. Mass. General ran afoul of these patient safety rules in 2009, leading to a painful examination of the hospital’s hard-driving surgery culture.

At the time, the ACGME found that a significant number of residents were working too many hours and were on the job seven days straight, in violation of patient safety rules. The organization believes heavy workloads contribute to fatigue-related mistakes.

According to a 2007 survey of Mass. General surgery residents, nearly 20 percent said they weren’t always getting a 10-hour break between shifts, while another 20 percent reported working more than the 88 hours per week allowed on certain especially difficult rotations.

The hospital responded by reducing residents’ workloads, generally having them work 6 a.m. to 6 p.m. shifts, requiring them to more stringently document their hours, and encouraging a culture in which senior doctors tell residents who have been working too long to go home. The hospital has 56 surgery residents this year.

Dr. Keith Lillemoe,cq the hospital’s new chief of surgery, said in an e-mail that the biggest difference is “the culture change that unless there are truly extenuating circumstances related to patent care, the residents know that maintaining the work hour rules is a high priority. The other major change relates to constant vigilance as to avoiding situations where the residents can not be compliant. If there is a problem, we work together to fix it so that the work hours can be maintained.”