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Safety Impact of Medical Residents' Work-Hour Changes Debated

After completing medical school, new doctors begin their careers in medicine by completing a medical residency in which they work unimaginably grueling hours under the supervision of other licensed physicians. In 2011, the Accreditation Council for Graduate Medical Education, known as ACGME, changed the restrictions placed upon medical residents' work hours. However, the implications of the new changes have been debated among those in the medical profession.

Under the new rules set forth by the ACGME, resident shifts are now limited to a maximum of 16 hours. Additionally, resident supervision has been increased.

While it would make sense that shorter work hours would reduce resident fatigue and stress in the workplace (and consequently hospital errors and other medical negligence), not all experts agree that it does. News-Medical.Net recently reported on a study that surveyed the opinions of first-year residents in surgery and surgery program directors about the new standards. The study was described by its authors in the Archives of Surgery.

Interestingly, the survey shows that a large majority of surgical program directors feel that the new hour cap would not decrease intern fatigue. Rather, they believe that fatigue would stay at the same level or even increase. The directors were much more likely than the residents to believe that the new standards would have a negative effect on medical learning and on the quality of patient care.

The study indicated that the residents were "markedly more optimistic" than the directors about the new standards. More than 60 percent of residents thought fatigue would improve under the new standards and that work intensity and resident stress would decrease.

The results of the study were so contentious in fact, that the authors were prompted to express concern about the potential for "discontent, disengagement, and dishonesty in reporting hours" if interns and their directors did not embrace the changes.

Future studies will undoubtedly be needed to determine the true effects of hour-restrictions on resident fatigue and quality of patient care. However, this study highlights the fact that a debate about the affects and implications of fatigue does exist within the medical community. In fact, many medical malpractice lawsuits can be traced back to mistakes that were made by exhausted or fatigued medical staff.

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