Tuesday, December 12, 2006
Resident Work Hour Limitations a Bad Thing??
Over the past few months, we have been working on a documentary about the impact of resident work hours. There have been many studies about this topic, primarily relying on questionnaires, but we decided to spend several weeks with resident doctors from different specialties to see for ourselves what their work hours and their lives were really like. Several things started to become apparent.
First off, it is true that resident doctors do routinely work shifts lasting longer than 24 hours. In fact, despite regulations put in place by the Accreditation Council for Graduate Medical Education, many surgical residents work 30-hour shifts twice a week on top of their regular daily hours, for a total of 80 to 88 hours a week. While the limit is 80 hours, an extra eight hours may be added, if used specifically for learning purposes.
It also became clear that anybody who is awake for 24 hours in a row has trouble staying awake and may nod off from time to time, usually in lectures or when in front of the computer finishing paperwork.
Finally, as we interviewed people from various facets of medical education, such as deans, chairmen of training programs, residents themselves and nurses, we realized that the regulation of work hours is a very contentious issue.
At heart is the obvious, which is the possibility that sleepy doctors might make more mistakes. And, according to a study released yesterday from the division of sleep medicine at Brigham and Women's Hospital, doctors in training reported that they were four times more likely to make a fatigue-related medical error after working five or more long shifts. Others will argue that resident doctors need to work the longer shifts so they can have continuity of care with sick patients. After all, if they leave the hospital in the middle of caring for a patient, couldn't that jeopardize care? And, what about the concern that doctors who have curtailed the number of hours in a residency program might not be trained as well for real-life practice as doctors who worked the longer shifts?
It is by no means an easy question. For now, the work hours will be regulated. I am eager, though, to hear what you think.
Look for CNN Presents: Grady's Anatomy coming to CNN in March.
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