Several factors prevented a randomized design, including resident work-hour limitations and residents not physically present at the study site.
Still, Mr. Sharon said that on principle he could not see putting limitations on residents in the settlements.
There are, however, a few additional noteworthy limitations: First, residents of some current MSA's are not separately identified in the early censuses, but are so identified subsequently.
Even though the elective had its limitations, the residents all expressed how they saw it as a fruitful experience.
Our findings validate published faculty concerns following the ACGME's announcement of work hour limitations for residents and echo the few studies reporting on changes in graduate medical education outcomes following implementation of the 2003 ACGME duty hour standards [ 3, 14, 16, 18, 19].
ACGME requirements have dramatically changed residency education over the last five years and limitations on resident duty hours implemented in 2003 have placed a burden on program directors to ensure that residents' time is well distributed between service duties and educational experiences [ 1].
Such frameworks have also been described as typically implicit, such that they serve as a backdrop to research and arguments put forward about the strengths and limitations of resident duty hour restrictions [ 20, 33].
Following a general work hour limitation for residents in the United States in 2003, several studies found reduced rates of emotional exhaustion six months to a year later [ 23- 25, 31], whereas one study indicated that no significant reduction was found after two years in a cohort of residents in orthopaedic surgery [ 17].
Due to ethical and financial constraints and because of limitation of resident work hours, simulators were introduced in the last decade [2].
Other limitations are that residents were from different years and consequently differed in expertise, which may have inflated the variance components of the residents.
