The Implications of Limiting Work Hours for Medical Residents
Mar 27, 2013, 9:00 AM
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited shifts for first-year medical residents, or interns, to 16 hours, in an effort to improve their well-being. But two studies published online this week in the Journal of the American Medical Association (JAMA) find that these regulations may not be improving resident well-being—and that they may be decreasing both the quality of care they provide and their educational opportunities.
Although interns worked fewer hours after implementation of the shift length restriction in 2011, researchers found no change in their sleep duration or symptoms of depression. That study, led by Srijan Sen, MD, PhD, of the University of Michigan in Ann Arbor, also found an increase in self-reported medical errors among interns (from 20% in 2009 to 23% in 2011). The researchers hypothesize that the increase in errors may be due, in part, to interns having to perform more handoffs—where medical errors are known to occur—and to a lack of additional clinical staff that may mean “residents [are] expected to complete the same amount of work as previous cohorts but in less time.”
Another study, led by Sanjay V. Desai, MD, of Johns Hopkins University, also found “unintended consequences” of duty hour regulations. Although that study found more consistent sleep patterns for interns, it also found that nurses, as well as the interns themselves, believed the quality of patient care suffered. Desai’s research team found a concerning balance between the interns’ workload and their time spent on educational activities. “Concerns have been raised about the competency achievable with less hospital experience during any fixed duration of training,” they write. “Opportunities were reduced with restricted shifts, many of which occur solely during evening hours, precluding participation in traditional core educational components of medicine residency programs, such as noontime conference and morning rounds.”
The new studies “provide valuable insight into certain dimensions of the ongoing discussion within and outside the profession related to resident education, sleep, well-being, and patient care delivery,” ACGME Chief Executive Officer Thomas Nasca, MD, MACP, told Reuters. “They do not, however, address other relevant questions, such as supervision by faculty and senior residents, actual clinical outcomes, preparedness of entering Interns for the duties assigned, and other dimensions of the learning environment that are relevant to the complex interactions inherent in the teaching and learning environment.”
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.