C. R. Schlick1, D. B. Hewitt1, C. M. Quinn1, R. J. Ellis1,2, K. E. Shapiro1, K. Y. Bilimoria1,2, A. D. Yang1 1Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center, Department Of Surgery,Chicago, IL, USA 2American College Of Surgeons,Division Of Research And Optimal Patient Care,Chicago, IL, USA
Introduction: Motor vehicle crashes (MVCs) are a leading cause of resident mortality. However, the overall rate of MVCs in general surgery residents is unknown, as are the effects of duty hour regulations on MVCs. Our objectives were to (1) examine the frequency of “nodding off” while driving, near miss MVCs, and MVCs in a national cohort of general surgery residents and (2) evaluate whether assignment to the Flexible Policy arm of the FIRST trial impacted MVC outcomes.
Methods: Residents from all US ACGME-accredited general surgery training programs were surveyed following the 2017 American Board of Surgery In-Training Examination (ABSITE). Outcomes of interest were nodding off while driving, near-miss MVCs, and MVCs after being on call. Exposure variables included frequency of duty hour violations, poor psychiatric well-being (as measured by the GHQ-12 assessment), and FIRST trial study arm. Group-adjusted cluster chi-square and hierarchical regression models with program-level intercepts were used to measure associations between resident/program factors and outcomes.
Results: Among 7,391 general surgery residents (response rate 99.3%) from 260 programs, 34.7% reported nodding off while driving, 26.6% a near-miss MVC, and 5.0% an MVC over the preceding 6 months. Nodding off while driving was associated with more frequent 80-hour rule violations (59.8% with 5+ months with violations vs. 27.2% with 0, OR 3.70 [95% CI 2.90-4.72]) and poor psychiatric well-being (41.2% in worst quartile vs. 23.4% in best, OR 1.80 [95% CI 1.55-2.09]). Near-miss MVCs were similarly associated with more frequent 80-hour rule violations (53.6% with 5+ months with violations vs. 19.2% with 0, OR 4.09 [95% CI 3.20-5.22]) and poor psychiatric well-being (36.7% in worst quartile vs. 12.9% in best, OR 3.07 [95% CI 2.60-3.64]). Residents were more likely to report MVCs with more frequent duty hour violations (14.0% for 5+ months with violations vs. 3.5% for 0, OR 3.01 [95% CI 2.08-4.35]) or poor psychiatric well-being (9.8% in worst quartile vs. 1.8% in best, OR 4.57 [95% CI 3.17-6.58]). FIRST trial study arm was not significantly associated with nodding off (34.0% in flexible policy vs. 36.3% in standard, OR 0.83 [95% CI 0.65-1.05]), near-miss MVCs (25.9% in flexible policy vs. 27.5% in standard, OR 0.85 [95% CI 0.66-1.08]), or MVCs (4.8% in flexible policy vs. 4.7% in standard, OR 0.97 [95% CI 0.67-1.41]).
Conclusion: Nodding off while driving, near-miss MVCs, and MVCs were more likely in residents with frequent duty hour violations and poor psychiatric well-being, but were not associated with FIRST trial study arm. Thus, although extended work hours may contribute to resident MVCs, flexible duty hour policies in surgical training are not associated with increased risk. Future interventions focused on minimizing violations of the 80-hour maximum weekly duty hour limit and improving psychiatric well-being may improve surgical resident driving safety.