Duty hour monitoring is required in accredited training programs, however trainee self-reporting is onerous and vulnerable to bias. The objectives of this study were to use an automated, validated algorithm to measure duty hour violations of pediatric trainees over a full academic year and compare to self-reported violations. Duty hour violations calculated from electronic health record (EHR) logs varied significantly by trainee role and rotation. Block-by-block differences show 36.8% (222/603) of resident-blocks with more EHR-defined violations (EDV) compared to self-reported violations (SRV), demonstrating systematic under-reporting of duty hour violations. Automated duty hour tracking could provide real-time, objective assessment of the trainee work environment, allowing program directors and accrediting organizations to design and test interventions focused on improving educational quality.

This study was limited to a single institution and does not include out-of-hospital EHR logs by design. Because actual shifts may exceed the boundary of in-hospital EHR use, this method may under-estimate but should not over-estimate duty hours for inpatient shifts. Accordingly, we observed 18% of resident-blocks with more SRV than EDV. This may represent either over-reporting of duty hour violations using self-reporting tools, or actual shift duration exceeding the bounds of EHR use. Additionally, 22% of resident-blocks were excluded from paired analysis because no self-reported shifts were logged by trainees.

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