Shorter hours said to shortchange residents

If a recent study that found residents believed administrative tasks during their compressed work weeks squeezed out educational activities is representative of programs nationwide, educators said the quality of U.S medical residencies could be compromised.

"My fear is that there will be an educational cost to many programs in the short term. If all you do is meet the new regulations and you don't re-engineer the entire system, you can compromise education," said Robert Wachter, MD, study co-author and associate chair of medicine at the University of California, San Francisco.

Learning after limits

The study, published in the January Academic Medicine, surveyed 164 internal medicine residents at three UCSF-affiliated hospitals shortly after the 80-hour-week restrictions went into effect in 2003. Among the findings:

• 69% reported spending the same or less time in educational activities such as teaching and conferences.
• 29% said their ability to attend conferences was negatively affected.
• 60% said they had not increased the time they spent reading.
• 78% said the hours limit had a positive impact on their quality of life.
• 72% said the time they spent doing nonmedical-oriented tasks at the hospital was unchanged.

"Because these young doctors take patient care very seriously, they'll skip the lecture when faced with a choice of a lecture versus patient care chores," said Susan Wall, MD, senior associate dean for UCSF's medical school.

Since the survey, UCSF has made changes to free residents from scut work, Dr. Wachter said. For example, the program has replaced daily noon conferences with a weekly half-day, off-site conference so that residents won't be tempted to check on patients.

Administrative hassles start early

The UCSF study is one of several examining duty-hour issues in January's Academic Medicine. The studies cover a variety of settings and use an array of measurements to examine the impact of reduced resident hours on patient care and resident education. In general, the studies showed that not only were residents finding that administrative tasks were eating into their educational time, but residents' shortened weeks were forcing this low-level work on to faculty and medical students.

Steven Daugherty, PhD, assistant professor in psychology and preventive medicine at Rush Medical College in Chicago, who has collaborated on resident education research, said the UCSF study, and others like it, might be too optimistic.

"The first lesson is that what's true for one hospital is not true for all," Dr. Daugherty said. "UCSF, for example, is a premier institution with forward-thinking people. If you find a slight decline in resident satisfaction in a premier program, one has to wonder if the others are having more difficulty."