Under an updated proposal from the Accreditation Council for Graduate Medical Education, first-year residents would be more closely supervised by experienced doctors, and the maximum length of their work shifts would be cut from 24 hours to 16 hours. In addition, all residents and their supervisors would be required to explain their roles to patients, making it clear that supervisors are ultimately in charge of their care.
Although many patient advocates and physicians have commended the step toward protecting patient safety, such a drastic cut in resident work hours would likely pose logistical and financial challenges for teaching hospitals, the Wall Street Journal reports. In addition, it may resurface concerns from when the 80-hour week was mandated in 2003, that such limitations may compromise doctors' education and ensuing skill set. Others, still, say the reforms wouldn't go far enough in preventing mistakes made by sleep-deprived student doctors.
The proposed new guidelines, published in the New England Journal of Medicine, are "an attempt to balance those [concerns] and to teach residents to learn their own limits," said Thomas Nasca, chief executive officer of the ACGME. One way the plan attempts to do so is by treating residents differently at different stages of their training. The 16-hour limit only applies to first-year residents, while those and their second year and beyond will stick with the 24-hour rule, with an additional four hours allowed to assist with patient handoffs.
If the new rules come to pass, Timothy Billiar, chairman of the department of surgery at the University of Pittsburgh, said the stricter duty-hour guidelines would be a "moderate challenge" for the department, which would need to hire additional medical staff, such as physician assistants or nurse practitioners, as it did when the 2003 guidelines went into effect. Adhering to the supervision requirements, however, would be a simple matter of documenting the monitoring that already takes place at the facility, Billiar said.
The guidelines are now open for a 45-day public-comment period. If approved by the board in September, the rules will go into effect in July 2011.
To learn more:
- read the article in the Wall Street Journal
- here's the WSJ Health Blog entry
- check out the Associated Press story in the Boston Globe
- see the abstract in the New England Journal of Medicine