The Effect of Residents’ Working-Hour Restrictions on Patient Safety, Resident Well-Being, and Resident Education: Protocol for a Systematic Review and Meta-Analysis

Introduction: Residents’ duty hour restrictions have been a source of debate throughout the years. Implementing restricted duty hours may help reduce sleep deprivation and workload, consequently improving patient safety and residents’ sense of well-being. Nonetheless, shorter shifts implicate an increased number of handoffs, where communication errors may arise, and less time for direct patient contact, where educational opportunities may be missed. Various observational studies have attempted to evaluate the effect of resident work hour reforms on patient safety outcomes. More substantial evidence has become available as randomized controlled trials have been published exploring the impact of resident duty hour restrictions on patient safety and residents’ wellbeing and education. An updated systematic review and meta-analysis are crucial to interpret this data.  Objectives: To evaluate the effect of resident physicians’ working-hour restrictions on patient safety parameters, residents’ perceived well-being, and resident education. Methods and analysis: Literature search strategies were developed using MeSH and free terms to be carried out in PubMed, MEDLINE, EMBASE, Cochrane, Clinicaltrials.gov, and Global Index Medicus with no restriction in language. Primary outcome measures include patient safety parameters, and secondary outcome measures involve resident well-being and education. We will test for heterogeneity of the included studies by employing the I2 statistical test; if significant (I2 ≥ 75%),  only qualitative narrative synthesis will be performed. If studies are homogeneous, a meta-analysis will be carried out.  For continuous data, we will calculate the mean difference or standardized mean difference. For dichotomous data, the risk ratio will be calculated. Results will be displayed on a Forest Plot.  Conclusions: It is essential to review the existing high-grade evidence regarding the impact of residents’ extended working hours so that authorities can optimize future graduate medical education regulations.