Editorials, Opinion Piece Address Recent IOM Recommendations On Work Schedules For Medical Residents

Main Category: Medical Students / Training
Also Included In: Sleep / Sleep Disorders / Insomnia;  Public Health
Article Date: 10 Dec 2008 - 3:00 PDT

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Two newspapers recently published two editorials and an opinion piece about recent recommendations by an Institute of Medicine committee that medical residents who work a 30-hour shift should have a five-hour, uninterrupted break to sleep after they have worked 16 hours. Summaries appear below.

Editorials

• New York Times: "The recommendations look strong in some respects but unrealistic at the core," according to a Times editorial. The editorial states, "The panel acknowledges that there is not enough evidence to assess the degree to which tired residents harm patients, but there are studies that show errors rising when shifts exceed 16 hours," adding, "The report's biggest weakness ... is the notion that a five-hour nap in the middle of a long shift is an adequate solution." The editorial states, "That mandate seems impossible to enforce, and few residents are likely to get five uninterrupted hours of sleep," adding, "A ban on shifts longer than 16 hours seems preferable" (New York Times, 12/9).
  
  
• USA Today: "You don't need a medical degree to know that sleep deprivation causes fatigue that impairs judgment and ability," but "that fact seems to escape educators at hospitals where the nation's 108,000 medical residents -- doctors in training who make critical decisions affecting patients' lives -- routinely work such punishing hours," a USA Today editorial states. The editorial states, "Monitoring must be strengthened with more unannounced visits," adding, "Tougher whistle-blower protection is needed because residents worry that complaints will damage their careers," and the Accreditation Council for Graduate Medical Education "needs to insist on overlapping schedules during shift changes to reduce the chances for error during the handoff of patients from one doctor to another." The editorial concludes, "Allowing residents to get adequate rest isn't a mushy-headed perk. It's the right medicine to prevent injury to patients" (USA Today, 12/9).
  

Opinion Piece
ACGME "appreciates the work of the ... committee in preparing its report on resident physician duty hours" and has asked for "written comment on the IOM recommendations from individual educators and residents, program directors and their associations, specialty boards and societies, other interested persons and organizations, and the public" to help improve accreditation standards, ACGME CEO Thomas Nasca writes in a USA Today opinion piece. He writes, "ACGME's responsibility and challenge are to create and enforce accreditation standards that will enhance, and not detract from, the development of the knowledge, values, skills and behaviors required of physicians." Nasca writes, "Working with its colleagues in medical education, ACGME will continue to enhance its systems relating to compliance with resident duty hour standards, as well as standards for educational process and outcomes," adding, "This will be accomplished by furthering the goal of improving health care by training physicians who demonstrate the knowledge, values, skills and behaviors required to serve the American public" (Nasca, USA Today, 12/9).

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