Recent Family Medicine Residency Graduates' Perceptions of Resident Duty Hour Restrictions

Abstract

Education (ACGME) set common standards for r'esident duty hours, with the goal of enhancing education and patient safety in teaching institutions.1 These restrictions limited residents to an average of 80 hours per week, with a maximum shift length of 30 hours, 10 hours off between shifts, and 1 day free of clinical duties per week. The initial restrictions were accompanied by requirements that faculty provide adequate and graduated supervision of residents, that programs educate faculty and residents as to signs of fatigue, and that programs and institutions prioritize patient safety. Before the ACGME could revisit its 2003 limits, the Institute of Medicine (IOM) responded to continued concern over patient safety by issuing a report calling for further changes. 2The IOM based its recommendations on studies showing that the 2003 standards had not resulted in added sleep for residents 3 or a reduction in resident fatigue. 4,5 Studies using Medicare and Veterans Administration data failed to show a positive effect of resident duty hour restrictions on patient safety or quality of inpatient care, 6-9 and one review found that positive changes for residents were balanced by negative changes for faculty.10 A recent systematic review found little or no change before and after duty hour restrictions on a diverse range of outcomes including examination scores, surgical volume, and quality of care measures. 11Program directors in a range of specialties have expressed reservations about these new restrictions, with

Developing the National Family Medicine Graduate Survey

“…15 Graduate survey data have also examined the effects of training on practice, such as the impact of reduced clinical and educational work hours and enhanced supervision requirements. 16,17 To date, no systematically collected national data exist to contextualize residency outcomes in family medicine.…”

Assessment of surgeon fatigue by surgical simulators

“…8,9 However, the studies have shown significant concerns about residents losing a central role in patient care, as well as limitations on the educational and training experience of residents. [10][11][12] Duty hour restrictions may help reduce the level of sleep deprivation resulting in trainee fatigue. However, many factors, such as physical and emotional stress, can also contribute to fatigue.…”