Over the last ten years, educators have vigorously debated the
rules and regulations governing residency training program work
schedules. Some educators believe that resident work hours must be
strictly limited. Two arguments are made for this view.
One focuses on the effect of long hours on the residents
themselves, and argues that traditional schedules involving long
shifts without sleep are simply brutal and dehumanizing. The other
argument focuses on the effect of long hours and resident fatigue
on patients and argues that tired residents make more mistakes and
Educators who oppose limits on work hours also make two
arguments. First, many believe that limits on resident work hours
make it impossible to adequately train residents. This, they argue,
will also harm patients by exposing them to doctors who are
inadequately prepared. Second, they argue that shorter work hours
disrupt continuity of care and lead to more mistakes as a result of
miscommunication among residents as they sign out to one another.
In 2003, resident work hours have been officially limited by the
committees that accredit residency programs. Further mandated
reductions are to kick in on July 1, 2011.
We present, here, some data on the effects of these changes. So
far, it seems, the reduction in work hours has not led to
measurable decrements or measurable improvements in the quality of
care. It has, however, led to residents who are somewhat better
rested. We will have to wait and see whether further reductions
lead to more dramatic changes, or whether work hours are not as
tightly correlated with patient outcomes as suggested by educators
on either side of the divide.
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