Reductions in residency training hours do not significantly affect quality of patient care, including inpatient mortality, according to a study published in the BMJ.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted a requirement that work weeks for residents not exceed 80 hours and that shifts not be longer than 30 hours. The changes came in response to a widely publicized death in a New York teaching hospital and to growing concerns about the safety of patients cared for by fatigued residents. Subsequent reforms in 2011 capped shift lengths at 16 hours for interns and 28 hours for trainees. However, in 2017, the ACGME allowed interns in some programs to work longer shifts, and made other changes as well.
“The reduction in resident work hours sparked debate as to whether working fewer hours during residency training would lead to physicians entering independent practice who were inadequately prepared,” author Anupam B. Jena, MD, PhD, Harvard Medical School, Boston, Massachusetts, told Medscape Medical News via email.
To answer the question, Jena and colleagues compared patient outcomes for physicians trained in internal medicine before and after the residency work hour reforms occurred. They found that the reduction in work hours was not linked to hospital mortality, readmissions, and costs of care.
“These findings should certainly inform the debate, though may not end it,” Jena said.
“It’s important to recognize that hospital care is different than what it was 20 to 30 years ago, in a way that reduces the role of a single physician in driving patient outcomes. It’s possible that the trainee of the future may adequately be prepared for independent practice with less than 80 hours a week during residency,” he explained.
With the data showing similar patient outcomes, one expert said the focus now needs to shift from discussing the total number of hours that residents spend in the hospital to how those hours are spent.
SOURCE: Medscape
