Open Access Research article

A qualitative assessment of internal medicine resident perceptions of graduate medical education following implementation of the 2011 ACGME duty hour standards

Christa R Nevin1*, Andrea Cherrington1, Brita Roy2, David D Daly3, J Martin Rodriguez1, Mukesh Patel4, Erin D Snyder1, Angelo L Gaffo1, Joseph Barney1 and James H Willig1*

Author Affiliations

1 University of Alabama at Birmingham, 845 19th Street South, BBRB 220B, Birmingham, AL 35294, USA

2 Robert Wood Johnson Foundation Clinical Scholars Program with support from the US Veterans Administration, Yale University, New Haven, CT, USA

3 Medical University of South Carolina, Charleston, SC, USA

4 University of Maryland Baltimore, Baltimore, MD, USA

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BMC Medical Education 2014, 14:84  doi:10.1186/1472-6920-14-84

Published: 22 April 2014



In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents.


We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, “How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?” Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans.


Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study.


Residents noted a decline in teaching and are concerned with the decrease in “hands-on” clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education.

Medical education; Medical education-graduate; Qualitative research