Statement From The American Academy Of Sleep Medicine And Sleep Research Society: Reforming Work Hours For Resident Physicians

Main Category: Primary Care / General Practice
Also Included In: Sleep / Sleep Disorders / Insomnia;  Public Health;  Medical Students / Training
Article Date: 19 Jun 2010 - 0:00 PDT

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In advance of a report on resident physician duty hours from the Accreditation Council for Graduate Medical Education (ACGME), the American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS) commend the ACGME for its independent and comprehensive review of resident physicians' duty hours. ACGME initiated the review in response to Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, a 2008 report from the Institute of Medicine (IOM).

As the leading professional organizations for the fields of sleep medicine and sleep research, the AASM and SRS call on the ACGME to implement safer work hours for the nation's approximately 109,000 resident physicians and their patients. We support the following requirements, based on peer-reviewed evidence showing the cumulative effects of sleep deprivation and the effects of circadian biology, for physician training programs:

• Duty hours for resident physicians must be limited to 16 consecutive hours.
• Duty hours for resident physicians must be limited to 80 hours per week.
• Duty hours must include at least one 24-hour off-duty period per 7-day period without averaging.

The current science in sleep concludes that acute and chronic sleep deprivation affects human performance, and, although individual variation exists, all humans become impaired after sufficient sleep deprivation. Data also show that sleep loss impairs brain function, concentration and coordination, and increases the risk of error. In fact, 24 hours without sleep doubles average reaction time, leading to impairment similar to legal alcohol intoxication . Moreover, 24 hours of sleep deprivation degrade clinical performance by resident physicians to the seventh percentile . Evidence also supports the relationship between fatigue and medical errors: according to one study, resident physicians averaging five or fewer hours of sleep per night were 1.5 times more likely to commit errors with adverse patient outcomes .

Clearly, balancing physician residents' practical need for comprehensive training and experience with their biological need for adequate sleep is an essential provision for quality patient care. Our endorsement of revised duty hours supports the essential care provided by resident physicians to patients, and emphasizes protection of our patients against fatigue-related errors.

Source:
Kathleen McCann
American Academy of Sleep Medicine

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