Duty Hour Regulations: Perceptions of Surgical Residents

Duty Hour Regulations: Perceptions of Surgical Residents

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) released its first regulations on work hours and supervision for residents. However, with these first regulations came much debate on how effectively duty hour limitations were at achieving the intended goals of improved patient safety as well as enhanced resident education. In 2011, the ACGME increased these regulations, a change that dramatically shifted traditional 24-hour in-house call schedules for many programs across the United States. The newest regulations require that interns have direct supervision from more senior residents or attending physicians at all times. The 2011 standards also limit first-year resident duty periods to a maximum of 16 hours and have a stricter 24-hour limitation for senior residents. “With the most recent ACGME duty hour regulations, the professional development of residents and the quality of their education has come into question,” explains Brian C. Drolet, MD. “The regulations inevitably lead to more frequent patient handoffs and less continuity of care.” Although fatigue can be an issue for patient safety, there is also evidence that frequent transfers of care and miscommunication can lead to errors. Surveying Views of Surgery Residents Previous studies have suggested that surgical residents believe some level of duty hour restriction is warranted, but they do not support significant regulation of duty hours. More recently, Dr. Drolet and colleagues had a study published in JAMA Surgery that examined surgical residents’ views of the ACGME requirements after they were implemented in 2011. The study assessed the perceived effects of the regulations on patient care, resident education, and quality of life. It also evaluated self-reported compliance and duty hour...

Surgeon Sleep Deprivation: The Case for Informed Consent

Sleep deprivation has been shown to adversely affect clinical performance and impair psychomotor function. It can be challenging for medical systems to ensure that physicians are not fatigued from sleep deprivation because continuity of care and around-the-clock coverage of clinical services are often competing needs. The Accreditation Council for Graduate Medical Education has revised its regulations on resident work hours to restrict trainees in their first postgraduate year to a maximum of 16 hours of continuous work, followed by a minimum of 8 hours off duty. “Unfortunately,” says Michael Nurok, MD, PhD, “there are no such regulations for fully trained physicians.” There are many reasons why fatigue from sleep deficiency occurs, including long work shifts, long work weeks, sleep disorders, or personal circumstances (Table 1). “Researchers have documented the adverse effects of sleep deprivation and sleep disorders on individual performance,” says Dr. Nurok. “In surgery, the risk of complications (eg, massive hemorrhage, organ injury, or wound failure) is thought to increase in patients who undergo elective daytime surgery when these procedures are performed by attending surgeons who have less than a 6-hour window for sleep between procedures during previous on-call nights. Performing elective surgery under these circumstances cannot be rationalized in the context of patient safety.” Elective Surgery & Rescheduling Unlike other practice areas, elective surgery is potentially amenable to rescheduling. However, many competing interests influence the possibility for rescheduling, even when all parties stand to gain by avoiding errors and complications (Table 2). “When no policy exists to facilitate rescheduling or to prohibit sleep-deprived physicians from working, the burden of deciding to proceed with operations or reschedule them...