A new professionalism? Surgical residents, duty hours restrictions, and shift transitions

BACKGROUND: Some anticipated that the Accreditation Council for Graduate Medical Education duty hours restrictions would foster a team-focused "new professionalism" among residents. This study explores the prevalence and challenges of a new professionalism and whether they vary by program size. METHOD: Questionnaires distributed in 15 general surgery programs produced an 82% response rate (N = 306); 52 semistructured follow-up interviews were completed. Results include means, percentage who "agree or strongly agree," significance tests, and main themes from the interviews. RESULTS: A new professionalism is limited by residents' reluctance to pass work from day to night teams, unclear guidance regarding stay-or-go decisions during shift transitions, little educational emphasis on sign-outs, and the practice of long hours in the name of professionalism. Program size is largely unassociated with these beliefs and behaviors. CONCLUSIONS: A new professionalism represents a stalled revolution among surgical residents. The new professionalism's emphasis on teamwork requires additional attention to staffing and workload management.