OBJECTIVE:: To investigate the long-term effect of flexible duty-hour policies on resident outcomes BACKGROUND:: The Flexibility in Duty Hour Requirements for Surgical Trainees trial showed no significant difference in overall resident well-being between flexible and standard duty-hour policies after 1 year. However, long-term exposure to flexibility could have adverse effects on duty-hour violations, resident satisfaction, and well-being. METHODS:: In 2014, 117 programs were randomized to flexible or standard duty-hour policy. Residents were surveyed annually following the American Board of Surgery In-Training Exam (~3750 residents/yr; response rate 99%). Four-year trends within the flexible policy arm were analyzed using cluster-corrected Chi-squared tests. Differences between study arms were modeled using multivariable logistic regression. RESULTS:: Over time, there was a trend toward fewer 80-hour work week violations in the flexible arm (19.8%–17.0%, P = 0.06), and increased satisfaction with flexible duty-hours (91.9%–94.3%, P < 0.05). Although well-being decreased over time (85.1%–81.5%, P = 0.01), this was seen globally with no difference between study arms [odds ratio (OR) 0.96 (0.74–1.25)]. Likewise, at the end of the study period, there was no association between flexible policy and duty-hour violations [OR 1.25 (0.95–1.61)] or satisfaction with duty hours [OR 0.80 (0.55–1.19)] compared to standard policy. Residents in flexible duty-hour programs reported significantly fewer lapses in continuity than standard policy residents, until all programs transitioned to flexibility by 2018. CONCLUSION:: Cumulative time under flexible duty-hour policies had no detrimental effects on duty-hour violations or resident well-being. After multiple years of flexibility, residents continue to report a high rate of satisfaction and positive effects on continuity of care.

BACKGROUND: Needlestick injuries pose significant health hazards; however, the nationwide frequency of needlesticks and reporting practices among surgical residents are unknown. The objectives of this study were to examine the rate and circumstances of self-reported needlestick events in US surgery residents, assess factors associated with needlestick injuries, evaluate reporting practices, and identify reporting barriers. STUDY DESIGN: A survey administered after the American Board of Surgery In-Training Examination (January 2017) asked surgical residents how many times they experienced a needlestick during the last 6 months, circumstances of the most recent event, and reporting practices and barriers. Factors associated with needlestick events were examined using multivariable hierarchical regression models. RESULTS: Among 7,395 resident survey respondents from all 260 US general surgery residency programs (99.3% response rate), 27.7% (n = 2,051) noted experiencing a needlestick event in the last 6 months. Most events occurred in the operating room (77.5%) and involved residents sticking themselves (76.2%), mostly with solid needles (84.7%). Self-reported factors underlying needlestick events included residents own carelessness (48.8%) and feeling rushed (31.3%). Resident-level factors associated with self-reported needlestick events included senior residents (PGY5 29.9% vs PGY1 22.4%; odds ratio 1.66; 95% CI 1.41 to 1.96), female sex (31.9% vs male 25.2%; odds ratio 1.31; 95% CI 1.18 to 1.46), or frequently working more than 80 hours per week (odds ratio 1.42; 95% CI 1.20 to 1.68). More than one-fourth (28.7%) of residents did not report the needlestick event to employee health. CONCLUSIONS: In this comprehensive national survey of surgical residents, needlesticks occurred frequently. Many needlestick events were not reported and numerous reporting barriers exist. These findings offer guidance in identifying opportunities to reduce needlesticks and encourage reporting of these potentially preventable injuries among trainees.