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Efforts to reduce residents' sleep deprivation and stress with mandatory reductions in work hours have not been popular with hospital attending staff, and now a new survey suggests that the rules are equally unpopular among the residents themselves.

Two-thirds of surgical residents who responded to a 20-question electronic survey said they objected to the 2011 Accreditation Council for Graduate Medical Education (ACGME) Common Program requirements, wrote Brian C. Drolet of Rhode Island Hospital in Providence, and colleagues.

In fact the rules are so unpopular that 20% of the 1,013 surgeons-in-training who answered the survey said that they falsified duty-hour records sometimes, 11% submitted fudged reports once a week, and 4% turned in faked reports daily, Drolet and colleagues reported online in JAMA Surgery.

"The 'spoiler' is that 50.1% of surveyed surgical residents under-reported duty hours, 62.1% falsely reported duty hours, and only 32.4% acknowledged complying with the ACGME duty hour rules," wrote Orlando C. Kirton, MD, from Hartford Hospital in Connecticut, in an invited critique.

"This is extremely troubling behavior that could inevitably lead to unwanted scrutiny and stewardship action by Occupational Safety and Health Administration and Congress," he wrote. "The ACGME rules are the law of the land. It is no longer about adoption but about adaptation and demonstrating resolve. Noncompliance is not an option and must not be encouraged."

Drolet and colleagues sent the email surgery to 4,140 residents training in general surgery or surgical subspecialties and received responses form 25% of the sample.

Half of the survey responders said patient safety remained the same as before the duty hours were imposed, they reported, while 38% said it worsened.

"The proposed benefits of the increased duty-hour restrictions -- improved education, patient care, and quality of life -- have ostensibly not borne out in surgical training," the authors wrote. "It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations."

More than half of responders (55%) said educational opportunities had worsened under the new work hour rules and 68% said there was less attention paid to preparation for senior roles -- a key concern in surgical residency programs.

Drolet and colleagues acknowledged that the study was limited by a low response rate, but added "its results demonstrate an overwhelming disapproval of the changes."

Four earlier polls of medical personnel regarding the duty-hour restrictions showed similar sentiments and results.

"Unfortunately," Kirton wrote, implementing the duty-hour rules "has left program directors and other educators without a mechanism to prospectively evaluate their effect on residency education."

"We are left with a 'one shoe fits all' approach based on empirical data in the absence of high-level evidence, because peer-reviewed published reports have not shown consistent effects of duty-hour restrictions on patient care, quality, or mortality rates," he stated.