More Sleep, Not Less Work, for Medical Residents

By Rita Rubin, USA TODAY
To improve patient safety, medical residents should get at least five hours of sleep after working 16 hours, concludes a report today. Since 2003, the Accreditation Council for Graduate Medical Education (ACGME), which oversees residency programs, has required that residents work no more than 80 hours a week, averaged over four weeks, and no more than 30 hours straight. Previously, residents often worked 100 hours or more weekly.

Concerned that cutting workweeks below 80 hours would shortchange residents' training, the new report's authors focused on increasing sleep, but some observers say that's not enough.

The report was written by an expert committee convened by the Institute of Medicine at the request of Congress and the Agency for Healthcare Research and Quality. The IOM is part of the National Academies of Science, which advises the federal government on science and technology.

Long work hours "is deeply ingrained in the medical training culture," Carolyn Clancy, director of the research agency, said at a news conference. "We believe it teaches them dedication, stamina and responsibility."

Despite the ACGME limits, "30 hours is pretty much the minimum" that residents work at a stretch, says Jenny Blair, a New Haven, Conn., emergency medicine doctor who's written about residents' fatigue.

But, says Michael Johns, IOM committee chair and chancellor of Atlanta's Emory University, "the science clearly shows that fatigue increases the chances of errors." His panel advises that:

•Residents get five days off a month — one more than the ACGME requires — so they can catch up on sleep.
•Moonlighting in any hospital be counted as part of the 80-hour weekly limit.
•Residents work no more than four straight night shifts and get 48 hours off after three or four.
•Hospitals provide a ride for residents too tired to drive home safely.

Ensuring that residents sleep isn't enough to improve patient safety, Johns emphasizes. The report also recommends limiting their patient loads, relieving them of tasks that don't add to their education and increasing supervision by experienced doctors.

Several people at the news conference said shifts should end at 16 hours, not continue after five hours of "protected sleep." Surveys suggest that half of residents don't take full advantage of chances to sleep at the hospital, and most don't turn off their pagers when they do sleep, Harvard sleep researcher Charles Czeisler said.

And Peter Lurie, deputy director of the Public Citizen Health Research Group, a Washington, D.C.-based consumer advocacy group, said the "protected sleep" requirement will be even trickier to enforce than the current ACGME work limits.


So, what do you think? With Malaysia's also practising "more than 100 working hours a week" regime, isn't it going to be endangering the patients as well? And they blame it on the lack of passion of medical students for the 5 cases of mental illnesses among housemen every month.

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