According to resident work-hours regulations adopted three years ago, doctors training in the United States are forbidden from working round-the-clock shifts more than twice a week. But a newly published study shows the rules are not strict enough to prevent serious harm to patients - including fatal mistakes.

  A study in the December 2006 issue of Public Library of Science (PLos) Medicine reveals that medical interns who work five extra-long shifts (24 consecutive hours or more at a time without rest) a month experience a 700 percent increase in their risk of making a fatigue-related mistake that harms a patient. The risk of making a fatigue-related, preventable mistake that results in the death of a patient saw a 300 percent increase. These data suggest there are tens of thousands of preventable injuries to patients annually.

  Guidelines for graduate medical education in the U.S. still allow up to nine shifts (each up to 30 hours at a stretch) per month. About 100,000 medical residents routinely work these extended shifts. Doctors make life and death decisions under these circumstances, yet the medical community has been hesitant to address this issue. It is AMSA's hope that these study results will demonstrate to the medical community that further regulation is essential to guarantee the preservation of patient and physician safety.

  "Overworked physicians are a danger to their patients, other doctors and hospital staff and to themselves," said AMSA president Jay Bhatt. "It is unacceptable that doctors making life-and-death decisions do so while sleep-deprived and suffering from fatigue. Physicians, hospital staff, hospital administrators, health care advocates, patients and legislators and policy makers must work together to make hospitals safer."

  For the study, Harvard Medical School researcher Dr. Charles Czeisler and colleagues at the Harvard Work Hours, Health, and Safety Study Group surveyed 2,737 first-year medical residents on their work schedules, sleep habits and days off. The residents also were asked to report over the course of the year any errors they made while on duty. The residents in this study reported making 156 fatigue-related errors that injured a patient and 31 mistakes that led to a death.

  This recent research is the latest in a growing body of scientific evidence that highlights the adverse effects of excessive resident work hours and a growing awareness that fatigued interns working 24-hour shifts make many more serious medical errors, have an increased likelihood of injuring themselves in needle-stick accidents and experience more than double the rate of resident/physician car accidents as those whose work is limited to 16 consecutive hours.

  AMSA believes that the resident duty hours regulations as adopted by the ACGME are currently insufficient to ensure maximized patient and resident safety and health, in part because there is no whistleblower protection. AMSA continues to advocate for federal legislation (such as the Patient and Physician Safety and Protection Act, S1297/HR 1228) to regulate work hours, provide whistleblower protection and threaten noncompliant hospitals with fines instead of accreditation withdrawal. AMSA supports and continues to work toward the implementation of work-hour regulations including (but not limited to) the following:

  -- the number of hours a resident may work per shift should not exceed 16 hours;
-- at least 10 hours of time off-duty between scheduled shifts and;
-- at least 1 full, continuous 24-hour period off out of every 7 days, without averaging off hours over a period of greater than 7 days.

  AMSA can provide assistance in reaching resident-physicians willing to comment on this issue.

  Click here to learn more about the Resident Work Hour Issue

  The American Medical Student Association (AMSA), with more than a half-century history of medical student activism, is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. With more than 68,000 members, including medical and premedical students, residents and practicing physicians, AMSA is committed to improving medical training as well as advancing the profession of medicine. AMSA focuses on four strategic priorities, including universal healthcare, disparities in medicine, diversity in medicine and transforming the culture of medical education. To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at www.amsa.org.