New Limits on Resident Hours May Compromise Quality of Training

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 published in Mayo Clinic Proceedings.

In recent years, training programs have faced restrictions on the length of work shifts for the least-experienced medical doctors. In 2010, the ACGME, which oversees residency programs, issued the most restrictive guidelines to date, ruling that 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, MD, MPH.

The survey, which was 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% of program directors said they believe that shortened shifts will interrupt 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," Reed said.

The majority (78%) of directors felt the restricted shifts are likely to result in graduates who fall short in the key competency areas defined by the ACGME, which include patient care, medical knowledge, interpersonal and communications skills, and professionalism. Among the various fields surveyed, directors of surgery programs expressed the greatest concern. “Further research is necessary to understand the particular concerns of directors of surgery programs," said Reed. “But it's possible some directors may feel residents will not get sufficient time in the OR.”

Moreover, residency directors were skeptical about whether the new limits will reduce physician fatigue. Among respondents, 65% felt that the limits will have no effect on fatigue, and 6% felt the restrictions may even increase fatigue. "Other studies have found that reducing work hours doesn't necessarily lead to people going home to sleep," said Reed.

The results of the study suggest that resident schedules require further evaluation and perhaps other tweaks to ensure both patient safety and high standards of physician education. "This will probably not be the final iteration of recommendations that are set in place," Reed noted. “Obviously patient outcomes are of the utmost importance, but training the future workforce of excellent physicians also is in patients' interests. I believe we'll continue to see these policies evolve."

Source: Mayo Clinic