New duty-hour standards get mixed reception from residents

A survey finds opinion divided about whether the rules, set to take effect in July, will improve their education and quality of life.

By Carolyne Krupa — Posted Jan. 3, 2011

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A slight majority of residents believe new duty-hour standards that go into effect in July will improve their quality of life, while nearly half said the standards could hinder their medical training, a recent survey found.

Fifty-one percent of residents agreed that the rules would improve their quality of life and well-being, and 28% said they would not. Twenty-one percent were neutral.

Meanwhile, 48% said the changes wouldn't positively affect their overall education compared with 26% who said they would, according to the survey, which was the subject of a perspective article Dec. 2, 2010, in The New England Journal of Medicine.

"The residents surveyed clearly have mixed opinions on many of the questions we asked," said Lucy Spalluto, MD, article co-author and fourth-year chief resident in radiology at the Warren Alpert Medical School at Brown University in Rhode Island. "However, residents seem most concerned that their education and preparation for more senior roles may be compromised by the changes."

The standards adopted by the Accreditation Council for Graduate Medical Education in September 2010 will limit first-year residents to 16-hour shifts, while other residents can work up to 24 hours per shift, plus four hours for transferring patients.

The rules will require training programs to step up supervision of the nation's 111,000 residents, educate them about the signs of sleep deprivation, and revise scheduling to minimize how often patients are transferred from one resident to another between shifts.

A total of 2,561, or 22%, of 11,617 trainees contacted, participated in the survey. "Our data show that the residents responding to the survey were a representative sample demonstrated by the distribution of respondents within specialties and each year of training," said article co-author Brian Drolet, MD, article co-author and second-year resident in plastic and general surgery at Alpert Medical School.

The survey results were no surprise, said Joanne Conroy, MD, chief health care officer of the Assn. of American Medical Colleges. "Change always creates a certain amount of anxiety among the people it affects, especially because when this survey was done we really didn't know what the implementation strategy would be," she said.

Medical schools have been developing those strategies since the survey was conducted in August 2010. Though most institutions wanted another year to implement the changes, they are working to revamp their programs, she said. "We have to figure out how to educate people faster and maybe in different ways," Dr. Conroy said.

But residents are skeptical that their education will benefit, according to the survey. Sixty-three percent of respondents said the changes would not help them be more prepared for senior roles, and 13% said they would be more prepared as a result.

Fifty percent said the rules would increase the length of residency and fellowship training, compared with 17% who disagreed.

On the issue of patients, 41% of residents said the standards would not improve the quality of patient care, and 33% said they would improve care. Residents were more split on how the standards would affect patient safety, with 34% saying they would have a positive effect and 39% disagreeing.

"Residents want to ensure that patients have real continuity of care -- to know not only about the information in the medical chart, but about the patient as a person," Dr. Spalluto said.

Thomas J. Nasca, MD, ACGME chief executive officer, said most of the responses focused on the shift limits and did not take into consideration other rule revisions.

"The majority of the reaction was to the 16-hour standard for interns," Dr. Nasca said. "Beyond that, I cannot gauge the familiarity of the respondents to the patient safety, quality improvement, professionalism and hand-over standards that are the heart of the change in focus of the standards."

Dr. Drolet said he hopes the survey findings will encourage residents to familiarize themselves with the new standards, and "that the ACGME will continue to assess how the revised standards impact resident education and patient care."

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External links

"Residents' Perspectives on ACGME Regulation of Supervision and Duty Hours -- A National Survey," The New England Journal of Medicine, Dec. 2, 2010 (link)

Accreditation Council for Graduate Medical Education 2010 standards for supervision and resident duty hours for graduate medical education (link)

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