Medical residents may face 28-hour work shifts

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The Accreditation Council for Graduate Medical Education (ACGME) has proposed changes to its rules governing residents that would allow them to work 24-hour shifts--a third longer than they are currently allowed to work--plus up to four more hours to manage transitions in care

It's an about face from about a decade ago when ACGME took actions to restrict some of the most brutal aspects of medical residencies, such as eliminating back-to-back shifts that could last as long as 30 hours apiece.

But the ACGME changed its thinking after a review of the latest research--including a study published this year by the New England Journal of Medicine, which concluded that longer hours for surgical residents did not necessarily pose any safety risks.

“Training to become a practicing physician can be compared to training for a marathon,” said ACGME Chief Executive Officer Thomas J. Nasca, M.D., in a statement (.pdf). “You must learn how to pace yourself, take care of yourself, and recognize your limits. With enough experience comes resilience and the ability to perform under expected, sometimes challenging conditions.”

Despite the potential expanded shifts, other restrictions will remain in place. Residents are restricted to working a maximum of 80 hours per week, and they will receive one day off every seven days. However, all of those numbers would be averaged over a four-week period.

Medical faculty and residents would be trained to recognize some of the collateral effects of such a work schedule, like burnout, depression and substance abuse.

The proposed changes, which are now subject to a 45-day public comment period, was criticized by the consumer advocate group Public Citizen, according to The Washington Post. Michael Carome, director of the organization's health research group, told the newspaper that studies have shown that exhausted residents are "a danger to themselves, their patients and the public."

In surveys, patients have said they are wary of expanding workshifts for first-year residents beyond 16 hours.

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