Limiting residents' work shifts may hurt continuity of care

Standards designed to improve patient safety may actually endanger the quality of medical residents' training, according to a study published in the March issue of Mayo Clinic Proceedings.

One of the new rules approved by the Accreditation Council for Graduate Medical Education to be implemented in July would limit the workday of first-year residents to 16-hour shifts. However, the study shows medical educators think the shift restrictions could do more harm than good, as the shortened shifts will prevent residents from providing continuous care to patients and from seeing and learning how patients' care progresses.

Of nearly 500 directors of residency programs in surgery, internal medicine and pediatrics, 78 percent said the 16-hour shifts would also endanger residents' competency in key areas defined by the ACGME: patient care, medical knowledge, interpersonal and communication skills and professionalism.

What's more, program directors doubted whether the new limits will reduce physician fatigue, the main problem the accreditation council sought to address. Sixty-five percent of respondents think the shorter limits will have no effect on overtired residents, while 6 percent think they may even increase fatigue.

"Obviously patient outcomes are of the utmost importance, but training the future workforce of excellent physicians also is in patients' interests," says Dr. Darcy Reed, Mayo Clinic internist and co-author.  "I believe we'll continue to see these policies evolve."

For more:
- read the Mayo Clinic study
- read this Chronicle of Higher Education article
- check out the new ACGME standards