On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) announced that first-year doctors will be allowed to work 24-hour shifts in hospitals starting July 1, 2017. The cap that has limited shifts to 16 consecutive hours of patient care since 2011 will be lifted. The 80-hours-per-week cap remains in place.
Balancing the logistics of physician training with the safety and needs of patients has been the subject of controversy and debate for decades. According to a recent article in the New England Journal of Medicine, the debate centers on the concern that longer hours mean less sleep and sleep-deprived residents might make errors. However, that is countered by other concerns about shorter work hours resulting in more patient hand-offs that could affect patient care.
Public interest in medical education and resident duty increased after a college freshman named Libby Zion died in a New York hospital in 1984, allegedly due to care she received from overworked and undersupervised residents. Resident duty hours became a focus of the ACGME, and policies were implemented and changed over the next three decades.
As to the latest hours rule change, ACGME reports that a Task Force spent 4200 hours over 18 months formulating the new resident requirements. The Task Force determined the hypothesized benefits associated with the reduction of first-year resident hours in 2011 were not realized. Further, the shift hours-cap purportedly disrupted team-based care and negatively impacted education of first-year residents.
The NEJM article describes two randomized trials that tested the existing hours policy. U.S. residency programs were randomly assigned to adhere to either standard ACGME duty-hour rules or flexible rules under which limits on shift lengths and time off between shifts were waived. The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial ran from July 2014 to June 2015, and the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial for medical residents ran from July 2015 to June 2016. The FIRST trial revealed no inferiority of patient outcomes in the surgical programs using the flexible duty-hour standards.
The results from the iCOMPARE trial were not yet available when, taking under consideration the outcome of the FIRST trial, ACGME reset its duty-hour rules to permit 24-hour shifts for first-year residents. Stay tuned for updates.
