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Work hour restrictions and the increased number of residents did not reduce the inpatient APEX over 20 years. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

March 13, 2026Open Access

Annual Patient EXposure of residents in training over 20 years (APEX-trial): a retrospective analysis from a public teaching hospital

Key Points

To analyze the annual patient exposure of residents in training over a 20-year period.
Retrospective analysis of patient data from a public teaching hospital
Assessment of work hour restrictions and resident numbers
Evaluation of case complexity and length of stay (LOS) trends
No reduction in inpatient annual patient exposure (APEX) despite work hour restrictions
Increased case complexity offset reduced APEX in the emergency department
Length of stay (LOS) trends also contributed to the findings

Abstract

In contrast to the general belief, work hour restrictions and the increased number of residents did not reduce the inpatient APEX over 20 years. The reduced APEX in the ED may be compensated by the increase in case complexity and the LOS.

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