Date of Degree


Document Type


Degree Name

Doctor of Philosophy (PhD)




Norman St. Clair


Noah Kasraie


Jose R Hinojosa


In 2003, the Accreditation Council for Graduate Medical Education and the American Osteopathic Association introduced new models that established limits on residents’ duty hours in training programs across the United States (Miulli & Valcore, 2010; Philibert & Taradejna, 2011); more stringent limitations were implemented in 2011. If these physician training programs decreased the time residents’ spent in a formal learning environment and utilized experiential learning as one teaching method, did the duty hour limitations affect the residents’ learning outcomes? The purpose of this ex post facto, quantitative study was to determine if there were differences in ITE (In-Training Examination) scores of family medicine graduates the year before and the year after duty hour limitations, 2003, as well as the year of duty hour limitations updates, 2011, at a community-based hospital residency program in South Central Texas. The study analyzed, for a span of 17 years, yearly ITE scores of residents who completed training in a community-based family medicine residency program (n = 355). Scores were divided into 3 groups. The first group included examination scores for the period 1997–2002 (109 residency graduates), when duty hour limitations did not exist. The post-implementation groups included examination scores for 2003–2010 (165 residency graduates) and 2011–2014 (81 current residents). The ITE consists of 240 questions covering a wide range of content categories. To analyze the ex post facto data from the ITE, a quantitative approach was used to determine if there were differences in scores of family medicine residency graduates before and after the year of duty hour limitations (2003) and from scores of current residents after duty hour limitations updates (2011). Univariate analysis provided descriptive statistics (gender, ethnicity, age). Inferential analysis determined if there were differences between the mean scores of the residents within the three groups of duty hour limitation periods. Analysis of this data indicated significant differences in the means of the ITE scores in 2 of the 3 duty hour periods. In addition, significant results were reported in the means of the adult medicine subcategory scores over 2 of the 3 duty hour periods, with no significant difference reported in the means of the maternity care subcategory scores. Based on the population for this study, results showed a significant difference in ITE scores after the duty hour limitation updates in 2011. These duty hour limitation standards are now a permanent fixture of postgraduate medical training. Researchers should continue to study educational outcomes related to resident work hours. Reporting on best practices would encourage duty hour limitations within individual institutions, be they university-based or community hospital-based residency programs.