Cutting Residents' Hours No Easy Task
Numerous public health groups sent a letter Feb. 4 to Dr. Thomas J. Nasca, executive director of the Accreditation Council for Graduate Medical Education, saying they fear patient safety is not being given sufficient consideration.
An array of public health groups headed by Mothers Against Medical Error and the Public Citizen Health Research Group are keeping the pressure on the Accreditation Council for Graduate Medical Education and its executive director, Dr. Thomas J. Nasca, to reduce work schedules of medical residents. But articles published in the second issue of the Journal of Graduate Medical Education last month suggest implementing the work hours proposed in 2008 by the Institute of Medicine will not be easy and may not be welcome. The public health groups' Feb. 4 letter to Nasca says as much: "Given press reports over the past year highlighting the academic medical community’s criticisms of the IOM recommendations as well as information on the ACGME website (Open Letter to the GME Community from Thomas J. Nasca, M.D., MACP, 10/28/09), we are fearful that the ACGME will choose not to adequately act on the evidence at this critical juncture," it says.
The letter, signed first by MAME President Helen Haskell and Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, also says the signers fear ACGME is not adequately weighing patient safety as it debates whether to act on the recommendations from the Institute of Medicine. The letter indicates a copy was sent to U.S. Rep. Henry A. Waxman, who chairs the U.S. House of Representatives Energy & Commerce Committee.
"We strongly urge the ACGME to make patient safety a central focus of its response to the IOM's recommendations," the letter states. "There is no scientific evidence to support the idea that a responsibly implemented reduction in working hours as contemplated by the IOM will limit educational opportunities or otherwise leave residents less prepared to practice medicine. Rather, there is abundant evidence showing that the ability of human beings to learn and to perform tasks is compromised by fatigue. Resident physicians are not immune to these universal physiological responses. The IOM recommendations limiting resident hours and workload, training residents in effective techniques for transferring patient information and improving supervision will, we believe, improve patient safety in the nation's teaching hospitals."
Public Citizen petitioned OSHA in 2001 to reduce residents' work hours. It says fatigued residents are at increased risk of depression, needlestick injuries, and car crashes on their way home, among other problems.
The journal, mailed to 10,000 recipients who include members of the ACGME Board of Directors and Review Committees, explores resident duty hours, resident burnout, professionalism, and the use of simulation in residents' education. An article titled "One Possible Future for Resident Hours: Interns' Perspective on a One-Month Trial of the Institute of Medicine Recommended Duty Hour Limits" illustrates the difficulty of implementing shorter schedules and says a "culture change" in residency training will be needed to accomplish the change. "Above all," the authors say, "we need to adjust and balance our workloads and to be supported by our attending physicians with realistic and consistent expectations and acceptance of a new culture of residency. If nothing else, we showed that a shift work model has potential —- it did not offer a definitive cure, but it suggested a start. As with most progress, it alleviated some issues while unveiling a host of other problems that must be addressed."