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The Accreditation Council for Graduate Medical Education (ACGME) has just announced new guidelines for resident work hours, which increases the maximum number of hours worked in a row to 24 hours. This is a change from the July 2011 guidelines which called for the limit to be capped at a maximum of 16 hours worked in row. Despite this significant change, it is important to note that core elements from the 2003 and 2011 ACGME Common Program Requirements have been maintained including:

 

  • Residents work hour are capped at 80 hours per week, including clinical and educational hours

  • Every week, residents must maintain one day free from clinical experience or education

  • Residents’ in-house call can be scheduled no more frequent than every third night

 

According to the ACGME, a study run over the past five years re-affirms that a cap of an 80 hour work week, first established in 2003, helps residents experience a healthy balance between real-world clinical experience and self-care included rest and exercise.

 

So why is the ACGME changing the guidelines to increase the cap of hours worked in a row? It may feel like there is a bit of tug of war between patient health and resident health.

 

Pros of 24-hour work period

  • Better patient outcomes. Studies have shown that fewer handoffs during patient care decreases errors and increases patient safety

  • Better resident training. This continuity of care also means a continuity in residents’ training.

 

Cons of 24-hour work period

  • Tired physicians. When physicians are overly tired it can lead to unsafe conditions for physicians, their patients and the public. Sleep-deprivation can put residents at a greater risk for car accidents and needle stick injuries.

  • Potential for burnout. Sleep-deprived residents are also at risk for depression, which can lead to burnout. Burnout is a concern across the career spectrum for physicians.

 

It is important to note that ACGME states that the increase 24-hour workday is the “ceiling not the floor,” and that some specialities never should have need for a 24-hour shift.  Are there ways to accommodate physicians who truly are not able to withstand the physical pressure of having to work 24 hours straight?  We believe that the answer is not a one size fits all approach. There is no magic solution to both decreasing the risks that come with handoffs and also preventing doctors from getting overly tired. After all, we would want doctors who were alert and able to take care of us if we were the patients!

 

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