Residents to work shorter shifts under more supervision

First-year residents will have more supervision and shorter work shifts starting in 2011, according to new standards adopted by the Accreditation Council for Graduate Medical Education.

The rules, issued Sept. 28, include requirements for graduated minimum time off, more regulation of handoffs in care and new standards governing fatigue awareness and management. They are an update to the ACGME's 2003 rules.

"The standards are clearly a transition to a new model of graduate medical education, because they more clearly articulate the core concepts in graduate medical education," said ACGME Chief Executive Officer Thomas Nasca, MD.

Those core concepts include patient and resident safety and managing transitions in care between shifts. The revisions, which better define supervision, emphasize how important it is for residents to recognize when they are sleep-deprived and need to seek backup help or take a nap before allowing fatigue to interfere with patient care, Dr. Nasca said.

First-year residents will be affected most. Their maximum work shift will be cut from 24 to 16 hours. They cannot moonlight or be on in-hospital call, and they must have a direct supervisor available at all times.

Many graduate medical education officials are concerned about implementing the standards by the July 1, 2011, deadline, said Joanne Conroy, MD, chief health care officer of the Assn. of American Medical Colleges. Some changes will be costly for institutions and require significant time and resources.

"Most of our program directors would like another year," Dr. Conroy said.

The ACGME board of directors released its proposed standards in June for 45 days of public comment. Board members reviewed feedback from more than 1,000 parties before approving the final rules.