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Study: Limiting Shifts For Medical Trainees Improves Satisfaction Without Affecting Educational Outcomes

March 23, 2018

Residents surveyed cite preference for limited-hour programs, but program directors report high levels of dissatisfaction with this approach compared to flexible-hour programs

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Study: Limiting Shifts For Medical Trainees Improves Satisfaction Without Affecting Educational Outcomes

Friday, March 23rd, 2018

Limiting first-year medical residents to 16-hour work shifts, compared to “flexing” them to allow for some longer shifts, generally makes residents more satisfied with their training and work-life balance, and makes their training directors more dissatisfied with curtailed educational opportunities, a new study from the New England Journal of Medicine has found.

For the study, investigators from the Johns Hopkins School of Medicine and the Perelman School of Medicine at the University of Pennsylvania surveyed and tracked the activities of thousands of first-year residents in 63 internal medicine training programs nationwide. The study—which is part of a five-year effort funded by the National Heart, Lung and Blood Institute and the Accreditation Council for Graduate Medical Education—also found that shift-length regulations have no impact on the residents’ activity or test of medical knowledge scores one way or the other.

“The effects of limiting trainee duty hours were not known,” says Sanjay Desai, associate professor of medicine and director of the Osler Medical Training Program at JHU’s School of Medicine. “A randomized trial with many institutions and generalizable findings was needed to inform the issue.”

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HUB

New Guideline Will Allow First-Year Doctors to Work 24-Hour Shifts

March 13, 2017

First-year doctors in training will now be permitted to work shifts lasting as long as 24 hours, eight hours longer than the current limit, according to a professional organization that sets work rules for graduates from medical schools in the United States

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New Guideline Will Allow First-Year Doctors to Work 24-Hour Shifts

Monday, March 13th, 2017

In setting the new standard, which goes into effect on July 1, officials at the Accreditation Council for Graduate Medical Education said on Friday that they hoped to avoid confusion and disruptions in care that can result when a patient is handed off to one doctor from another whose shift is ending.

The rules do not change for residents after the first year, who have been permitted to work 24-hour shifts if necessary. The new rules also leave in place a requirement that all residents work no more than 80 hours a week.

But the new guidelines roused the ire of critics who say that exhausted and inexperienced residents will be working too many hours to remain alert and focus on the critical decisions they make. The issue has been a focus of controversy for at least 30 years, after a patient named Libby Zion died under the care of residents in a New York hospital.

“We know sleep-deprived people can have impaired motor skills and their memory can deteriorate,” said Dr. Michael A. Carome, director of health research at Public Citizen, an advocacy group.

Image: By Shanghai killer whale – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18546351

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NYTimes

Why So Many Young Doctors Work Such Awful Hours

February 22, 2017

Neither truck drivers nor bankers would put up with a system like the one that influences medical residents’ schedules

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Why So Many Young Doctors Work Such Awful Hours

Wednesday, February 22nd, 2017

The path to becoming a doctor is notoriously difficult. Following pre-med studies and four years of medical school, freshly minted M.D.s must spend anywhere from three to seven years (depending on their chosen specialty) training as “residents” at an established teaching hospital. Medical residencies are institutional apprenticeships—and are therefore structured to serve the dual, often dueling, aims of training the profession’s next generation and minding the hospital’s labor needs.

How to manage this tension between “education and service” is a perennial question of residency training, according to Janis Orlowski, the chief health-care officer of the Association of American Medical Colleges (AAMC). Orlowski says that the amount of menial labor residents are required to perform, known in the profession as “scut work,” has decreased “tremendously” since she was a resident in the 1980s. But she acknowledges that even “institutions that are committed to education … constantly struggle with this,” trying to stay on the right side of the boundary between training and taking advantage of residents.

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The Atlantic

Study Finds No Harm In Allowing Surgeons-In-Training To Work Longer Shifts

February 2, 2016

Patients suffered no extra harm when doctors training to be surgeons were allowed to work longer shifts, a study released Tuesday concludes, adding to a push to relax the strictest limits on resident hours

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Study Finds No Harm In Allowing Surgeons-In-Training To Work Longer Shifts

Tuesday, February 2nd, 2016

The New England Journal of Medicine study comes as the Accreditation Council for Graduate Medical Education is reassessing requirements that prevent residents from working extremely long stretches or back-to-back shifts. Those rules were enacted in 2003 and strengthened in 2011 amid concerns that sleep-deprived residents were more likely to make serious errors.

Since then there has been push back from residency program directors concerned that the rules created new dangers for patients by abruptly forcing interns to leave in the middle of treating a patient or surgery. They also complain the rules interfere with resident education because it is harder for a trainee to follow their patients.

The study released Tuesday conducted a direct experiment by tracking patient outcomes after loosening the rules for doctors in 58 surgical residency programs. It found that their patients did not die or suffer complications any more than at 59 residency programs that did not waver from the current rules.

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KHN