Trainee Doctors Need More Sleep And Supervision, US Report

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Main Category: Medical Students / Training
Article Date: 03 Dec 2008 - 11:00 PDT

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A new report from medical and scientific experts recommends among other things that trainee doctors' hours and workload in the US be reduced and their supervision be increased because they make too many fatigue-related medical mistakes and they need a better learning environment.

Titled "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety", the report was written for the Institute of Medicine, edited by members of a National Research Council Committee and published by the The National Academies Press. The study whose findings are described in the report was sponsored by the US Agency for Healthcare Research and Quality.

The IOM was set up in 1970 under the charter of the National Academy of Sciences to give independent, objective, evidence-based advice to the man or woman in the street as well as to health professionals, policymakers, the private and public sectors.

The new report does not recommend a reduction to the 80 hours a week maximum set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003; instead it suggests that the maximum number of hours a trainee doctor can work without sleep should be limited to 16, and they should also have more days off in between duty shifts, and spend less of their time off doing other paid work ("moonlighting").

(The ACGME is the body through which doctors in the US get their medical qualification which involves spending time in "residency" as a practising trainee.)

Changing trainee doctors' hours is not enough to guarantee patient safety; they need more and better quality supervision by experienced physicians, and their caseload should be commensurate with their experience and area of specialism. And there should be more overlap in their shift patterns so that there is less chance of mistakes when cases are handed over from one trainee to another.

The report found that cost and lack of staff are the two biggest barriers to allowing this to happen. The authors said more money was needed to fund teaching hospitals and they estimated that the cost of offloading residents' excess work onto other health workers would be in the region of 17 billion dollars a year.

Michael M.E. Johns, chancellor, Emory University, Atlanta and chairman of the committee, said that:

"Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn."

"Health care facilties can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest. But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training," he added.

The recommendations to reduce residents' maximum shift duration and to increase their opportunity to catch up on sleep are underpinned by research that shows how fatigue can undermine performance. The authors came up with two ways to do this since no model accommodates the needs of all types of training environments and specialisms.

One option they suggested was residents could work a maximum of 16 hours in one shift. The other option was they could work a 30-hour shift as long as they had a chance to grab an uninterrupted 5-hour sleep break after working for 16 hours. Such sleep breaks should count as part of the 80 hours in the ACGME limit.

The authors also recommended that between shifts there should be off duty periods according to how long the shifts were and when they happened. Plus, the number of mandatory days off should be higher and there should be a cap on moonlighting during off-duty hours.

The study found that the current limit on duty hours was frequently violated and went unreported. The authors said that ACGME should strengthen the way they monitor how well hospitals comply with the limit; they should also make more surprise visits.

"Resident Duty Hours: Enhancing Sleep, Supervision, and Safety."
Cheryl Ulmer, Dianne Miller Wolman, Michael M.E. Johns, Editors, Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, National Research Council.
The National Academies Press, 2008, 480 pages.

Click here to order the report and also for link to read it online for free.

Sources: IOM.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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