New standards limit the work days of medical interns to 16 hours per work shift, down from 24 hours, and set stricter requirements for exceptions. Second-year residents may work a maximum of 24 hours continuously in a hospital. The standards were issued Tuesday by the Accreditation Council for Graduate Medical Education.
In the delicate balancing act between promoting patient safety and packing in as many training hours as possible, work seems to prevail over sleep. Residency programs should encourage residents to take "strategic naps," especially after 16 hours of continuous work and between 10 p.m. and 8 a.m., according to the new standards. The ACGME task force decided that the uninterrupted 5-hour sleep recommended by the IOM after resident work shifts of at least 16 hours was not realistic. Instead, a section of the standards on alertness management and fatigue mitigation notes that programs must adopt fatigue mitigation processes--also known as naps or back-up call schedules--to manage the potential negative effects of fatigue on patient care and learning.
The new rules also beef up supervisory requirements and include a whole page about the types of close supervision first-year residents should expect. The standards also explain that residents must demonstrate specific skills before getting more responsibilities.
A medical student group, the American Medical Student Association, told the Associated Press that the changes don't do enough to protect sleep-deprived residents and their patients. The group had lobbied for a blanket work-hour cut for all residents, not just first-years. "The fight for safer work hours is not over," Sonia Lazreg, the group's health justice fellow, told the AP.
To learn more:
- see the new ACGME approved standards on residency duty hours (effective July 2011)
- here's the ACGME press release
- read the commentary from the New England Journal of Medicine
- here's the Associated Press story
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