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J Surg Educ. 2017 May 18. pii: S1931-7204(17)30050-8. doi: 10.1016/j.jsurg.2017.05.008. [Epub ahead of print]

A National Cross-Sectional Study of Surgery Residents Who Underreport Duty Hours.

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Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:
Duke University, Durham, North Carolina.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
The Mayo Clinic, Rochester, Minnesota.
The University of North Carolina School of Medicine, Chapel Hill, North Carolina.



Previous work demonstrates that many surgery residents underreport duty hours. The purpose of this study was to identify characteristics of these residents and better understand why they exceed duty hours.


During the winter of 2015 we conducted an anonymous cross-sectional survey of Accreditation Council for Graduate Medical Education accredited general surgery programs.


A total of 101 general surgery residency programs across the United States.


A total of 1003 general surgery residents across the United States. Respondents' mean age was 29.9 ± 3.0 years; 53% were male.


Study response rate was 31.9%. Residents age <30 were more likely to exceed duty hours to complete charting/documentation (68% vs. 54%, p < 0.001). Females more often cited guilt about leaving the hospital (32% vs. 24%, p = 0.014) as to why they exceed duty hours. Programs with >40 residents had the highest rates of underreporting (82% vs. 67% in other groups p < 0.001) and residents who worked >90 hours on an average week more frequently cited external pressure (p = 0.0001), guilt (p = 0.006), and feeling it was expected of them (p < 0.0001) as reasons why they underreport compared to those who worked fewer hours.


Underreporting and duty-hour violations are a complex issue influenced by many variables including age, sex, and internal and external pressures.


Patient Care and Professionalism; duty hour violations; graduate medical education; underreporting

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