Residents' Duty Hours: Toward an Empirical Narrative

The 1984 death of a young woman due to a U.S. teaching hospital error led to a public discussion about sources of errors linked to medical trainee education and patient safety. This article examines the debate around medical resident duty hours, specifically noting the discrepancy between duty-hour limits and the evidence base to support them.

Both authors, Robert Wood Johnson Foundation Clinical Scholars, are currently trainees, recently finishing as editorial fellows at The New England Medical Journal. The aim of this article is to understand how the effects of duty-hour rules can be rigorously assessed. The authors interviewed members of the Accreditation Council for Graduate Medical Education (ACGME), patient advocates, program directors, educational experts, and trainees.

Key Findings:

  • ACGME acknowledges the creation of a uniform standard forces rules to cater to the lowest common denominator, as opposed to being specifically and uniquely suited to different environments.
  • Key data, while important, do not always reflect the whole story, often communicating biases that can lead to incorrect conclusions.
  • More and larger randomized trials are difficult to conduct on duty-hours due to lack of appropriate controls within a diverse system.

The implementation of resident duty hour rules requires a mechanism for adequate evaluation, the authors argue, suggesting ACGME grant programs a research exemption to address the issues of evaluation.