Doctors in Training: Effectiveness of Work-Hour Restrictions
Brandon T. Sawyer
In the current medical education system, resident doctors are trained through a “trial by fire” method—a learn by doing experience designed to give residents the rigorous experience that he needs to become proficient in the practice of medicine. Until recently, residents in training were known to log over 110 hours per week in the hospital. On July 1st, 2003, the ACGME (Accreditation Council for Graduate Medical Education), the independent non-profit organization in charge of accrediting all US residency programs, implemented new guidelines restricting resident work hours to no more than80 hours per week. The policy was implemented in hopes of improving resident education while at the same time ensuring a safe and high quality of care for patients seen by learning physicians. Many felt that the ACGME policy was too restrictive and would adversely affect patient care and resident education; while many others thought the ACGME had not gone far enough. Four years later, little has changed about the collective attitudes towards the work-hour restriction. Many still hold the same pro/con positions towards the policy; however, many are still left wondering when significant benefits of the restriction will be seen. Currently, residency programs are still developing ways to comply with the regulation. Many programs have taken measures such as hiring more support staff and implementing new scheduling systems to better deal with the work formerly taken on by new doctors in their years of residency (Yoon 2668) In addition, subspecialties such as neurosurgery are still brainstorming ways (no pun intended) to replace resident’s lost exposure to surgical procedures. So the question should be asked, with so much change caused by the work-hour restriction, has the policy really accomplished the intended goal of providing safe and quality healthcare while improving medical education? The best authoritative literature to date suggests that the policy has failed to make measurable improvements in the overall quality of patient care and safety, or in resident education. Language of Change and its Effects According to the ACGME web site, current duty hour restrictions include:
• An 80-hour weekly limit, averaged over four weeks.
• An adequate rest period, which should consist of 10 hours of rest between duty periods.
• A 24-hour limit on continuous duty, with up to six added hours for continuity of care and education.
• One day in seven free from patient care and educational obligations, averaged over four weeks.
• In-house call no more than once every three nights, averaged over four weeks. (ACGME) The ACGME enforces the work-hour restriction though several methods, including confidential resident surveys, interviews with program directors and students, and review of work hour documentation, such as time sheets and on-call schedules. While the ACGME has required all accredited US residency programs to comply with the regulation, how the work-hour restriction is implemented and managed is left up to the individual residency programs. Residency programs have responded to the policy by ongoing revisions to their scheduling of residents. Ensuring that hospitals have enough doctors on duty to admit and care for patients while following the work-hour restriction has been difficult. The University of California San Francisco, has implemented a “night float” shift, involving a resident who admits patients during the night and passes these patients off to other residents in the morning (Okie 2665). Other programs such as the emergency medicine residency program at Denver Health, a University of Colorado.........continued in print version.
