Resident Duty Hours Recommendation from the IOM

Medical experts propose limiting residents' work hours to improve patient safety.
NBC Nightly News (12/2, story 9, 2:15, Williams) reported, "A report [Tuesday] from the Institute of Medicine is taking a stand on a big and long-running problem in medicine." The organization "said that working for 30 consecutive hours creates an unsafe working condition, that is hazardous both to physicians and to the patients for whom they care."

According to the New York Times (12/3, A23, Parker-Pope), the "national panel of medical experts proposed significant and costly changes for training new doctors in the nation's hospitals, recommending mandatory sleep breaks and more structured shift changes to reduce the risk of fatigue-related errors." This "experts' report...focused on the grueling training of medical residents, the recent medical school graduates who care for patients under the supervision of a fully licensed physician. The medical residency, which aims to educate doctors by immersing them in a particular specialty and all aspects of patient care, is characterized by heavy workloads, 80-hour work weeks, and sleep deprivation." Notably, while "a series of changes, including limiting residents to an 80-hour workweek and 30-hour shifts," has been made in recent years, "the expert panel said those reforms were not enough," because "caps on work hours are often not enforced, and many residents still do not get enough sleep, putting doctors and patients at risk for fatigue-related mistakes."

Therefore, in order "to improve patient safety," the panel members recommend that "medical residents...get at least five hours of sleep after working 16 hours," USA Today (12/3, Rubin) adds. At present, "the Accreditation Council for Graduate Medical Education (ACGME), which oversees residency programs," requires that "residents work no more than 80 hours a week, averaged over four weeks, and no more than 30 hours straight. Previously, residents often worked 100 hours or more weekly."

The Washington Post (12/3, A6, Brown) adds that the proposed "work rules for physicians-in-training...are considerably more restrictive than those that went into effect in 2003, but are widely violated." For instance, "a survey of about 4,000 interns found that in the first year those rules were in effect, 84 percent reported working shifts that violated them at least one month of the year." Meanwhile, "43 percent reported working more than 80 hours weekly."

The AP (12/3) notes, "At issue is how to balance patient safety with the education of roughly 100,000 medical residents. ... The long hours are in some ways a badge of the profession; doctors can't simply clock out if a patient is in danger." Yet, "sleep deprivation fogs the brain, a problem that can lead to serious medical mistakes."

The report, which is titled Resident Duty Hours: Enhancing Sleep, Supervision and Safety, "also warned that violations of the 80-hour limit occur frequently and are underreported," the Salt Lake Tribune (12/3, Rosetta) reports. Therefore, the "ACGME should more closely monitor teaching hospitals' compliance." In addition, it "recommends greater supervision of residents by experienced physicians, limits on patient caseloads based on residents' levels of experience and specialty, and overlap in schedules during shift changes to reduce the chances for error during the handover of patients from one doctor to another." The Boston Globe (12/3, Cooney), Modern Healthcare (12/3, Lubell) and Scientific American (12/3, Lite) also cover the story.

The one-page summary recommendation is online at
http://www.iom.edu/Object.File/Master/60/471/one%20pager%20revised%20for%20web%202.pdf

Nancy Delanoche, MS
Associate Director, Office of Graduate and Undergraduate Education
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington VA, 22209-3901
Tel: 703-907-8635, Fax: 703-907-7849