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Survey: Better Hours For Residents? Not So Fast

By Jenny Gold

February 22nd, 2013, 2:32 PM

The new rules regulating duty hours were supposed to make life easier for medical residents, but both program directors and doctors-in-training give the changes mixed reviews.

These latest changes, implemented in July 2011, limit first-year residents, also called interns, to 16-hour shifts. They were put in place by the private, nonprofit Accreditation Council for Graduate Medical Education, and were intended to prevent medical errors resulting from sleep deprivation. Second- and third-year residents are still be permitted to work 28 hours at a time. But in the last four hours, they can’t take on new patients.

A survey of residency program directors was published Thursday in the New England Journal of Medicine. Of 549 responses, 73 percent reported that under the new rules residents were less prepared to take on more senior roles. Another 65 percent said that resident education had gotten worse, and only 6 percent reported that patient safety and quality of care had improved.  Meanwhile, less than half thought resident quality of life had improved.

The residents themselves also negative views of the changes.  A similar survey of 6,201 residents published in NEJM in June found that while 62 percent felt that quality of life had improved for interns, half reported that quality of life had gotten worse for senior residents, who were picking up the slack. Meanwhile, 41 percent reported that the quality of their education had gotten worse, and 48 percent disapproved of the rule changes.

Dr. Brian Drolet, who conducted both surveys and is also a fourth year resident at Rhode Island Hospital, says he was surprised that reactions to the regulations were so negative. “The intentions were good, but the actual impact has not actually been what was intended,” he says. Resident hours, he explains, are always a “trade-off between continuity and fatigue.” Tired doctors may make errors more likely, but so does increasing the number of times a patient is handed off from one doctor to another at the end of a shift.

The changes can also make life more difficult for senior residents and attending physicians who take on more responsibility when interns are off duty.

“A certain degree of regulation is needed to prevent abusive situations, but you have to be careful about how strict you make the learning environment,” Drolet argues. The accrediting council “should be responsive to the potential that the impact is negative and maybe add some flexibility.”

Drolet plans to present the surveys at the ACGME annual meeting next week.

4 Responses to “Survey: Better Hours For Residents? Not So Fast”

  1. steve says:

    The problem I see is that the so-called “experts” in resident training never go abroad to see how other countries handle these situations. We never seem to do comparisons with healthcare systems that seem to work better than our own. We all know that America has the worlds most expensive healthcare system by at least twice the cost. However, does resident training in Canada or the UK or Japan work better than resident training here in America. We will never know, will we? Nobody ever does such comparisons because, in most cases, they come away embarrassed at how stupid we do things in resident training and in healthcare in general. We have an inept healthcare system that is the most expensive in the world and healthcare professionals, hospitals and healthcare insurance companies seem to be proud of owning that distinguished honor. As I see it, America is at least 20 years behind all of the other industrialized nations of the world when it comes to resident hours and resident training. Expert? Yeah, right!

  2. Miles Rudd, MD says:

    I find that the work hour reforms are unrealistic in comparison to what rural physicians do as part of their everyday practice. New residency grads come out with a false expectation as to what a rural physician lifestyle is like. My patients need a physician that is able to care for them no matter what the time of day. We share call, but when we are on duty, at times we need to be able to function with little or no sleep for more than a 24 hours. My experience in training helped to prepare me to be able to handle this.

  3. david bilstrom says:

    Having had seven months of 36/12 rotations during my straight internship, i knew fatigue all too well. Nevertheless, the house staff always had more senior residents and fellows there to help with problems. Our teaching staff physicians were intimately involved in our training and decision making. The key to the success was and should be the involvement of the staff physicians in requiring the very best from us.

    It is not the time that is critical, it is the level of involvement of the serior house staff and staff physicians that make the difference. I had the good fortune of having such an experience. I was very tired most of the time and had the very good fortune of having a wonderful supportive spouse.

  4. david bilstrom md says:

    Having had seven months of 36/12 rotations during my straight internship, i knew fatigue all too well. Nevertheless, the house staff always had more senior residents and fellows there to help with problems. Our teaching staff physicians were intimately involved in our training and decision making.

    It is not the time that is critical, it is the level of involvement of the serior house staff and staff physicians that make the difference. I had the good fortune of having such an experience.

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