Some resident work-hour limits could change

The Accreditation Council for Graduate Medical Education is considering modifying duty-hour standards for residents in response to feedback from program directors.

During its annual conference in March in Chicago, Ingrid Philibert, vice president of field operations for the ACGME, said changes being considered included raising the weekly average for chief residents in surgical programs to 88 hours, up from the 80 hours originally set July 1, 2003. Program directors have argued that this is a key year for training.

Also under review is the 10-hour rest period following in-hospital call. The ACGME is looking at ways to credit residents for sleep gotten during the on-call period and counting it toward the recommended break.

The ACGME will consider changes during its June meeting, and revisions could take effect as soon as July 1.

As of January, the ACGME had approved 53 requests from programs seeking a 10% increase to the 80-hour weekly average and denied 17. Neurosurgical programs made the largest number of requests.

During this first year of resident duty-hour limits, the ACGME noted, many programs found the 24 hours on-call duty plus six hours for patient transfers difficult to work under. Programs also noticed residents were spending less time with faculty, presumably because faculty were taking on more clinical duties as a result of the residents' shorter hours.

Programs in urban areas said attempts to hire more staff to offset the loss of resident hours weren't always successful.

The ACGME also said it found some programs were so focused on being technically compliant that they were ignoring aspects of patient safety. One program in New York City, for example, was assigning its on-call resident to cover two separate hospitals blocks apart, a situation that was completely unworkable.