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Education panel OKs standards limiting resident work hours


By Andis Robeznieks
Posted: September 29, 2010 - 11:00 am ET
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Calling for “a culture of professionalism that supports patient safety and personal responsibility,” the Accreditation Council for Graduate Medical Education board of directors approved new work standards for doctors in training (PDF) that limit their duty hours to an average of 80 hours a week and limits first-year residents to 16-hour workdays.

Starting in their second year, residents will be allowed to work for 24 consecutive hours—with “strategic napping” strongly suggested but not required. The new standards take effect July 1, 2011.

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“Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education,” the introduction to the new standards states. “It is physically, emotionally, and intellectually demanding, and requires longitudinally-concentrated effort on the part of the resident.”

The introduction also notes that a physician's education is “experiential” and is required to take place “within the context of the healthcare delivery system,” and the goal of a residency program is the acquisition and development of the skills, knowledge and attitude required for the unsupervised practice of medicine and establishing a foundation for continued professional growth.

Under the new standards, first-year residents are not permitted to work other clinical jobs, a practice known as “moonlighting.” After the first year, residents are allowed to moonlight, either internally or externally, but that time will be counted against their 80-hour work limit and must not interfere with a doctor-in-training's ability to meet educational objectives.

On their own initiative, residents will be allowed to exceed daily work limits to continue to provide care to a single patient if continuity is required for a severely ill patient, if an educational opportunity presents itself or for “humanistic attention to the needs of a patient or family.”

The new standards require residency programs to provide “alertness management/fatigue mitigation” and to manage potential negative affects on education and patient care with napping or backup call schedules.

The ACGME, which accredits some 8,800 programs that train 111,000 residents, released a preliminary revision to the standards in late June, and said it received comments on the proposed changes from some 1,000 interested parties.

A cost analysis of the new standards is expected to be released next week.

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