Residents’ working hours shortened as of July 2011

fatigue and residents, medical errorsWill policies to reduce medical residents’ fatigue may compromise quality of training? Is learning more important than fatigue-induced medical errors? The debate rages as we approach a deadline of July 2011, which will limit residents’ working hours to no more than 16.

Recent Accreditation Council for Graduate Medical Education (ACGME) limits aimed to enhance patient safety may compromise the quality of doctors’ training, according to a study by Mayo Clinic researchers published in the March issue of Mayo Clinic Proceedings (http://www.mayoclinicproceedings.com).

Patient safety has long been a critical concern for hospitals, in particular for those training new doctors. Since 1984, when the death of 24-year-old Libby Zion at a New York hospital was attributed to an overtired medical resident, training programs have faced restrictions on the length of work shifts for the least-experienced medical doctors. Last year, the ACGME, which oversees residency programs, issued the most restrictive guidelines to date: Residents should serve no longer than 16-hour shifts in the hospital.

“Our results showed that the duty-hour limitations may not be a quick fix to an important problem,” says Mayo Clinic internist and co-author Darcy Reed, M.D., M.P.H. (http://www.mayoclinic.org/bio/12376205.html).

The survey sent to directors of residency programs around the country found that many are concerned that the duty-hour limitations to be implemented by July 2011 will impinge on physician education. Of the nearly 500 respondents from the fields of surgery, internal medicine and pediatrics, 87 percent of program directors felt that the shortened shifts will interrupt the interactions between residents and hospitalized patients. “Many survey respondents expressed concern that the limits will decrease the continuity of care. As residents face more handoff of responsibilities within a 24-hour period, they have less opportunity to see and learn how patients’ care progresses,” Dr. Reed says.

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Is this concern valid? Is this resistance to change? A doctor told me that limiting hours for residents did not prepare them for the “real” world after training was over. I would hate to be harmed, or see a person I loved harmed, by a well meaning but sleep-deprived resident.

See also “Long nursing shifts could harm you”. What do you think about limiting residents’ hours to 16?

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