Work-hour limits reduce resident fatigue and confidence

A survey of Harvard orthopedic surgery residents finds they feel rested despite not using their off time to get more sleep.

By Carolyne Krupa — Posted Nov. 20, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Restrictions on the number of hours in a week that resident physicians can work have helped decrease fatigue among young physicians but may make them less prepared to practice medicine, according to an Annals of Surgery study published online Oct. 12.

Researchers surveyed 216 orthopedic residents before and after the implementation of work-hour rules by the Accreditation Council for Graduate Medical Education in 2003. Residents reported feeling less fatigued as a result of the changes, although the amount of sleep they received did not change significantly. Residents surveyed slept an average of 34.6 hours per week in 2003, compared with 33.7 from 2004 to 2009, the study said (link).

“This really challenges one of the primary assumptions about duty-hour standards — that if you let obviously-tired residents go home earlier more often, that they would sleep more. But they’re not sleeping more,” said Debra Weinstein, MD, senior study author and vice president for graduate medical education with Partners Healthcare in Boston.

The results suggest that residents’ perceptions of fatigue are related to other factors, she said. “It’s not just about sleep. There may be other ways that fatigue is impacted. It may be that more leisure time is more important.”

All physicians in the study participated in the Harvard Orthopaedics Combined Residency Program. Implementation of the ACGME rules reduced the number of hours per week residents spent performing major procedures, from an average of 31 in 2003 to 25.4 in 2004-09.

Residents surveyed after 2003 also cited significantly less confidence in their preparedness to make clinical decisions under stress and lower satisfaction with their educational experience. The number of hours the average resident worked decreased from 74.5 hours per week to 66.2 in 2009, the study said.

The 2003 rules limited resident workweeks to 80 hours, with a goal of improving patient safety and ending the 120-hour workweeks that had become common during training. They also placed new requirements on the supervision of residents and their workloads.

In July 2011, the ACGME implemented revised rules. Changes included increasing resident supervision, limiting first-year residents to 16-hour shifts, educating residents and faculty about sleep deprivation, and ensuring effective transfers of patient care.

At that time, council officials called for more studies to monitor the impact of work-hour standards and guide future revisions.

ACGME Chief Executive Officer Thomas J. Nasca, MD, said the Annals study contributes to that growing body of research. “This is a well-constructed study that adds to the mosaic of research studies on the impact of resident work-hours standards implemented by the ACGME in 2003,” he said.

Dr. Weinstein said more research is needed. “I don’t think anyone sees the current requirements as the final stop in this evolution. This is an evolving issue where we are continuing to learn the impact of work-hour limits,” she said.

Back to top


Lessening the impact of resident fatigue

A survey of 216 Harvard orthopedic residents before and after the implementation of ACGME work-hour restrictions in 2003 found a decline in residents reporting negative effects from fatigue, according to an online Annals of Surgery study.

Area negatively affected by fatigue 2003 2004-09
Ability to learn 88.6% 75.0%
Overall resident satisfaction 71.4% 68.9%
Co-worker interactions 58.8% 44.4%
Overall resident well-being 57.1% 63.0%
Ability to provide psychosocial support 57.1% 44.8%
Quality of care 45.7% 25.6%
Patient safety 28.6% 14.4%

Source: “Long-term Follow-Up on the Educational Impact of ACGME Duty Hour Limits,” Annals of Surgery, published online Oct. 12 (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn