Resident Duty Hour Changes Prompt Preparation and Reaction

Marcia L. Frellick

Disclosures

May 11, 2017

Changes to duty-hour restrictions for first-year residents that take effect in July are being met with relief by those who believe that this flexibility will improve care, and with trepidation and frustration by those who say the new hours pose a safety risk for patients and physicians.

As previously reported in Medscape Medical News, the Accreditation Council for Graduate Medical Education (ACGME) rules will lift the 16-hour shift cap as of July 1. First-year residents may soon work as long as 28 hours at a time, with the last 4 hours designated for managing care transitions. The 80-hour-per-week rule remains intact. In a written statement announcing the rule change in December, Thomas J. Nasca, MD, the council's CEO, said "Residents must develop the skills and the confidence to manage challenging situations under supervision, and must learn to care for patients over extended hours and during night-time hours, because these are circumstances they will encounter after graduation."

With the changes about to take effect, reactions are pouring in as preparations are being made.

Wait for iCOMPARE

Francis Deng, MD, was an intern in the internal medicine residency program at Brigham and Women's Hospital in 2016-2017 and a clinical fellow in medicine at Harvard Medical School in Boston, Massachusetts. He called ACGME's decision to revert to pre-2011 rules "premature." "It seems that it was primarily based on results from the FIRST [Flexibility in Duty Hour Restrictions for Surgical Trainees] trial and pressure from the surgical community," he told Medscape. "They're spinning it as a lot of flexibility for programs...but it's primarily going to benefit surgical programs, who feel they have a culture where working extended shifts would be beneficial."

Results of the FIRST trial were published in the New England Journal of Medicine and concluded that longer shifts for surgical residents do not diminish patient safety or demoralized trainees. Dr Deng points out that the iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education) trial, which is comparing extended shifts with nonextended shifts, has yet to finish. He suggests this study may show different results.

"You can't just take the FIRST trial results and apply them to all programs in all disciplines, because the structure and the culture of different residencies in different specialties are different. It remains to be seen whether these changes in internal medicine or anesthesia or emergency medicine would be as advisable," he stated.

Dr Deng explained that he does see a benefit in admitting a patient to the hospital at night and then still being around the next day when the day team discusses that patient in morning rounds. But he fears that the longer hours will result in more needle-sticks and car accidents for physicians and feels that longer shifts will further challenge work/life balance.

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