Medical residents, for the most part, are not giving high marks to new duty-hour restrictions that were designed to improve their education, workload and quality of life, according to a new report posted online by the New England Journal of Medicine.
Middling marks for resident work limits: survey
Of the 6,202 residents responding to an online survey this past February, most appeared to have either neutral or negative attitudes toward the new rules, which capped the length of shifts for first-year residents at 16 hours and 24 hours for other residents. The rules also mandated that residents get 14 hours off after a 24-hour shift and that residents must get one day a week off.
The only situation that a majority of respondents said the new rules had improved was the quality of life for first-year residents: 61.8% said the situation was better, 20.3% said it was unchanged, and 17.9% said it had gotten worse.
In contrast, 49.7% said the quality of life for senior residents had gotten worse, 36.5% said it remained unchanged, and 13.9% said it had improved.
Also, 72% said handing off patients between doctors had increased—although the effects on patient safety are unclear as 52.6% said patient safety remained unchanged as a result of the new rules, while 27% said it had gotten worse, and 20.4% said it had gotten better.
Almost 43% said the quality of their education remained unchanged, while 40.8% said it had gotten worse, and 16.3% said it improved.
The Accreditation Council for Graduate Medical Education first limited residents to an 80-hour workweek in 2003, and then refined those limits after a 2008 Institute of Medicine report called for further restrictions.
These results led the authors of the report to conclude that “the intended and actual effects of the 2011 ACGME duty-hour requirements may not be aligned.”
The authors, researchers from Brown University, Providence, R.I., and Vanderbilt University in Nashville, sent invitations to participate in the survey to the “designated institutional official” responsible for ACGME compliance at all 682 ACGME-accredited residency programs. Of those, 123 institutions in 41 states agreed to participate. (The report notes that 33 officials refused to participate and cited “survey fatigue” as the reason.)
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