New standards for resident duty hours to be enacted in July 2011

New resident duty-hour recommendations from the Accreditation Council for Graduate Medical Education have been released and are available for public comment until August 9, according to a report published in The New England Journal of Medicine.

The Accreditation Council for Graduate Medical Education (ACGME) has established a task force to “consider all comments and make modifications as needed,” according to the report, which added that the new standards will be enacted in July of 2011.

The July 2003 version of the ACGME’s resident duty-hour standards were released with the added promise that they would be revisited in 5 years. In 2008, the Institute of Medicine released a report modifying the ACGME’s duty-hour standards and criticizing the ACGME’s effectiveness at enforcing those standards.

According to the report, the educational community and the public have pointed out three elements of the 2003 standards that proved ineffective or dangerous:

The creation or exacerbation of the “shift mentality.”
Duty hours becoming the primary focus for programs and institutions rather than a catalyst for a greater learning experience.
Difficulty of complying with the established standards in the face of circumstances such as staying with a sick patient due to perceived professional responsibility.

The report also stressed that studies using national data samples “failed to show that the duty-hour limits had a positive effect on the quality and safety of inpatient care.”

A new approach

The new standards, according to the report, aim to reduce concerns that identical standards being applied to different specialties and residents at different levels are proving inhibitive to proper education. Furthermore, beyond the simple limitation of hours, the new standards seek to aid residents in being more involved with institutions to enhance safety and quality of care.

“The goal of the ACGME’s new approach to duty hours is to foster a humanistic environment for graduate medical education that supports learning and the provision of excellent and safe patient care,” the report noted. “The graduate medical education community has a moral responsibility to prepare residents to practice medicine outside the learning environment, where they will be unsupervised, must think independently, and must function when fatigued.”

The unpredictable experience

The new standards focus on the importance of supervision and teaching, improvement of the process by which patients are handed over, and education in terms of alertness management.

“Illness and the need for medical care are unpredictable, and circumstances arise when physicians must overcome fatigue to help patients in need,” the task force wrote.

In addition, the ACGME will strengthen its efforts to ensure institutions are complying with the new standards. These efforts will include experts in the fields of safety, sleep medicine, and graduate medical education.

“The ACGME’s new comprehensive standards will enhance the quality and safety of patient care in teaching hospitals, meet the clinical educational needs of residents, and benefit the future quality and safety of care when residents trained under the new standards enter independent practice,” they concluded.

Nasca TJ. N Engl J Med. 2010;doi: 10.1056/NEJMsb1005800.