The Institute of Medicine and the Accreditation Council for Graduate Medical Education have proposed changes to the “Common Program Requirements” for residents’ work duty hour requirements.

While the Association of Pediatric Program Directors (APPD) concurs with most of the principles put forth in the proposed standards, it has expressed concerns about two areas:

1. Limiting intern shifts to 16 hours will have unforeseen consequences. This proposed change would not allow residents time for reflective learning (meaningful interaction with supervisors/teachers and patients), follow-up with patients and handover of care or attendance at team rounds, ensuring a smooth transition in care without errors. APPD proposes that the intern duty hour limit be extended an additional four hours. Without this extra time there will be a slower progression to competency and an increase in patient handovers.
2. The short time frame to implement changes is unreasonable. The economic impact of the proposed changes has not been studied. Hiring replacements to fill the reduced intern hours will take time, if such personnel are even available. Hospital administrators also would need time to adjust budgets for an increase in costs.

The APPD recommends that pilot studies be done and analyses conducted so that change occurs in a planned and evidence-based manner.

[This research was not funded by the Robert Wood Johnson Foundation.]