Study finds widespread resident work-hour violations

The Accreditation Council for Graduate Medical Education disputes these results, stating that the majority of residencies are in compliance.

By Myrle Croasdale — Posted Oct. 2, 2006

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Some 43% of medical interns are working more than 80 hours a week in violation of Accreditation Council for Graduate Medical Education standards, according to researchers with the Harvard Work Hours, Health and Safety Group.

The study was conducted the first year duty-hour limits were imposed, but researchers said current data suggest further noncompliance.

These data, published in the Sept. 6 Journal of the American Medical Association, contradict results reported by the ACGME, which found only 5%of residencies in violation of its standards in 2003-04.

The study is the latest from the Harvard group of sleep experts that has called into question ACGME standards intended to curb resident fatigue and limit errors.

In the same issue of JAMA, a second Harvard study found that interns were at a higher risk of needlesticks during extended shifts. Previous studies from the Harvard team documented fatigue-related medical errors during the 80-hour schedule with 30-hour call shifts and found a link between residents, 30-hour shifts and car crashes.

"In the face of this evidence, it's ethically imperative that we change the system," said lead researcher and study author Christopher Landrigan, MD, MPH, of Brigham and Women's Hospital in Boston. "The standards that we have right now are not evidence-based, and it's becoming increasingly evident that residents are not safe."

The study sampled 1,278 interns via monthly e-mails surveying participants on their hours and other topics.

Dr. Landrigan said there were two things that need to happen. First, what constitutes adequate work-hour limits should be redefined. Second, a new mechanism to enforce these hours should be created independent of the ACGME.

David C. Leach, MD, ACGME's executive director, disagreed with the Harvard group's conclusions.

The ACGME looks for a pattern of noncompliance before considering a program to be in violation of its standards, Dr. Leach said, unlike the Harvard study labeling programs noncompliant after a single claim.

If the study's standards were used by the ACGME, 25% of its programs would have been in violation in 2003-04, compared with the Harvard study's 43%, Dr. Leach said.

"It's a mistake to focus on one variable in a very complex system," he said. "Improving patient care and resident learning involves many variables. It is quite possible to be fully compliant with duty hours and in doing so compromise both patient care and resident learning."

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External links

"Interns' Compliance with Accreditation Council for Graduate Medical Education Work-Hour Limits," abstract, Journal of the American Medical Association, Sept. 6 (link)

Harvard Work Hours, Health and Safety Study (link)

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