December 03, 2008

Curbs urged on long shifts for young doctors

New limits are needed to ensure that the long hours logged by young doctors in training at hospitals do not leave them so exhausted that they make medical errors, a U.S. expert panel said on Tuesday.

A panel of the Institute of Medicine, in a report sought by Congress and the Department of Health and Human Services, did not call for further trimming of medical residents' work hours from the maximum average of 80 per week established by the Accreditation Council for Graduate Medical Education in 2003.

But the committee recommended limiting the number of hours that residents work in a row without being given time to sleep from the current 30 hours, as well as increasing their days off and ensuring greater supervision by experienced doctors.

The panel said these doctors in training should work a maximum shift of 16 straight hours or alternatively work a 30-hour shift that includes an uninterrupted five-hour nighttime break for sleep after working 16 hours.

There has been concern for years that long work hours leave residents fatigued and more prone to make mistakes.

The Accreditation Council for Graduate Medical Education, or ACGME, the nonprofit group that evaluates and accredits U.S. medical residency programs, in 2003 limited the number of hours per week a resident could be made to work.

"Our committee's charge was not to focus necessarily on longer scheduling or shorter scheduling, but smarter scheduling to try to really identify the areas where we could have an impact in preventing excessive fatigue, both acute and chronic, that might contribute to medical errors," Dr. Daniel Munoz of Johns Hopkins University School of Medicine in Baltimore, a member of the panel, said in a telephone interview.

These junior doctors frequently are the front-line medical staff on duty around the clock in teaching hospitals. Residency training takes three to seven years.

"It ought to be rigorous. But it also ought to be humane and it ought to be safe for both patients and for residents," Munoz said.

As an illustration of the fatigue residents may experience, the panel noted that research has shown they have an increased risk of being involved in traffic accidents or falling asleep at the wheel after an extended-duty shift.


The panel urged the ACGME to adopt the recommendations within two years. The independent Institute of Medicine provides advice to U.S. policymakers.

"Cutting hours alone won't do it," added Dr. Ann Rogers of the University of Pennsylvania School of Nursing in Philadelphia, who also served on the committee.

"We need to pay attention to work load. We need to pay attention to supervision. The whole package will make a difference. Without it, you could end up with a more severely stressed resident trying to do more work with less hours."

Rebecca Sadun of the American Medical Student Association said the recommendations are "unambiguously a step in the right direction." She said the 2003 limits have proven to be insufficient because the current 30-hour shifts do not enable residents to remain at a high level of functioning throughout.

Sadun, a medical student at University of Southern California's Keck School of Medicine, added that her association hears many accounts from residents about how the current 80-hour work weeks in reality are 100-hour work weeks, with school administrators insisting that residents fill out time logs dishonestly.

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