Consider longer residencies to reduce long hours and the errors they cause

LETTER — Posted Dec. 27, 2004

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Regarding "Hours worked do make a difference" (Article, Dec. 6): This study further validates that sleep deprivation and extended work hours without proper rest impair psychomotor functions. As reported, 36% more serious errors were made by interns who worked the traditional 80-hour-per-week schedule with some shifts of 24 hours or more than that of 63 hours per week with no more than 16-hour shifts.

Of great significance is that the types of serious errors appear to be in the areas of medication and diagnosis -- areas that demand a clinician's full mental alertness and unimpaired cognition. As previously reported by the Institute of Medicine, tens of thousands of medical errors are made annually in hospital settings, resulting in serious death and injuries. It is of clinical interest to know how many of these errors were due to fatigue resulting from sleep deprivation and extended work hours. A well-structured study will help answer this question.

But even at the 63-hour-per-week schedule with no more than 16-hour shifts, the reported rate of serious errors per 1,000 patient days was 100, a number that, in my opinion, is still high. Whether this rate is acceptable in exchange for obtaining adequate medical educational experience for residents while maintaining the current length of residency training for most programs is debatable. For surgical training programs, in particular, wherein residents are required to perform a certain number of surgical cases, shortening the work schedule may affect these programs adversely.

But given the complexity and the vast volume of medical information that residents are required to master and the need to maintain mental alertness and sharpness in providing medical care during training, medical educators are facing a daunting task of providing a balance of both -- not to mention the economic impact of residents working fewer-hour schedules on institutional balance sheets in an era of inadequate reimbursements, higher patient loads and stagnant funding.

Perhaps it is about time the Accreditation Council for Graduate Medical Education take a serious look at lengthening the course of residency training for certain programs.

Khiem T. Tran, MD, Kyle, S.D.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/12/27/edlt1227.htm.

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