Morbidity in surgery: impact of the 50-hour work-week limitation in Switzerland.

PRINCIPLES: Work-hour regulations for residency programmes in Switzerland, including a 50-hour weekly limit, were set in on 1 January 2005. Patient safety was one of the major arguments for the implementation. As the effect of the restriction of residency work hours on patient care in Switzerland has not yet been evaluated on objective data, the aim of the present study was to assess its impact by comparing the patients' morbidity and mortality before (2001-2004) and after (2005-2008) the implementation. METHODS: Retrospective analysis of records of the Spitalzentrum Biel AG, a large referral center classified according to the Swiss Medical Association, collected in the database of the Association for Quality Assurance in Surgery (AQC), a prospective database of consecutive patients undergoing surgical procedures in Switzerland. A selection of 2,686 patients with common surgeries, operated on by residents, was performed. RESULTS: There were 1,259 (46.9%) patients meeting our inclusion criteria who were admitted during the period before introduction of work-hour limitation and 1,427 (53.1%) patients after introduction. The in-hospital mortality and postoperative surgical complication rate were significantly higher after the reform (p <0.05 and p <0.01, respectively). No significant differences could be found concerning the overall intraoperative (p = 0.61) and postoperative medical complication frequencies (p = 0.08). CONCLUSIONS: The work-hour limitation implemented in Switzerland was not associated with surgical patient safety measure improvement for common surgeries (i.e., morbidity and mortality rate). Further research on a nationwide basis is needed to assess the value of the higher surgical complication and mortality rate.

Students' interest in becoming a general surgeon before and after a surgical clerkship in German-speaking Switzerland.

PRINCIPLES: The proportion of medical graduates entering a surgical career in Switzerland, as well as in most Western countries, is declining. The purpose of the present study was to evaluate the factors influencing medical students when choosing a career in surgery and to identify the impact of a surgical clerkship. METHODS: Between February 2007 and July 2007, fifth- to seventh-year medical students at 15 adult surgical departments in German-speaking Switzerland were asked to participate in an anonymous survey. The survey was distributed at the beginning of the clerkship (T1) with a re-evaluation after its conclusion (T2). It included questions concerning career plans, the anticipated conditions at the workplace, lifestyle in residency and as a board-certified physician, and the perception of surgery. RESULTS: A total of 185/344 (53.8%) medical students participated in the study. Prolonged working hours during the surgical training period compared to those of other specialties was the only significant predictor for not choosing general surgery as the future field of work (p = 0.02). After the clerkship, medical students rated the possibility of combining professional and personal life, and engaging in a hobby during specialty training in surgery significantly higher (p <0.01 and p = 0.03, respectively). The specialty was named by 33% further students as one of their top three career choices. CONCLUSIONS: A surgical clerkship might have a positive impact on the choice of a surgical career. As there might be a shortage of surgeons in the future, lifestyle as the main impediment for choosing a surgical career should be kept in mind.