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Survey: Many program directors concerned that duty-hour limits may impact quality of resident training
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A survey conducted by Mayo Clinic investigators revealed that many U.S. residency program directors are concerned that recently announced Accreditation Council for Graduate Medical Education limits on work hours may compromise the quality of doctor training and continuity of patient care.
“Our results showed that the duty-hour limitations may not be a quick fix to an important problem,” Darcy Reed, MD, PhD, an internist and study investigator, stated in a Mayo Clinic press release. The findings were recently published in the Mayo Clinic Proceedings.
Reed and colleagues surveyed 713 eligible residency program directors, and 464 responded. The investigators found that 78% of directors felt the duty-hour limitations, set to be implemented by July 2011, would likely result in graduates who fall short in key competency areas defined by the Accreditation Council for Graduate Medical Education (ACGME), which include patient care, medical knowledge, interpersonal and communications skills, and professionalism. According to the release, directors of surgery programs expressed the greatest concern.
“Further research is necessary to understand the particular concerns of directors of surgery programs,” Reed stated in the release. “But it is possible some directors may feel residents will not get sufficient time in the OR.”
The survey also revealed that 87% of respondents noted that they believed the new ACGME recommendations will reduce residents’ continuity with hospitalized patients. “As residents face more handoff or responsibilities within a 24-hour period, they have less opportunity to see and learn how patients’ care progresses,” Reed stated in the release.
In addition, 65% of respondents thought implementing the new duty-hour restrictions will not impact resident fatigue, and 6% thought that the limits may increase fatigue.
References:
- Antiel RM, et al. Mayo Clin Proc. 2011;86(3):185-191.doi:10.4065/mcp.2010.0635.
- www.mayoclinic.com
The Mayo Clinic Proceedings have published two studies and an editorial dealing with residency program directors’ attitudes about and efforts to accommodate the many recent changes to resident duty hours. The first article authored by Ryan Antiel et al suggests that there is significant concern among program directors that the Accreditation Council for Graduate Medical Education escalating duty hour restrictions pose a threat to the education of a “competent generation of future physicians.”
Christopher McCoy et al reported on the results of a proactively developed 16 hour maximum continuous duty program in anticipation of the formal restrictions that will take effect in July 2011. After demonstrating the feasibility of complying with this mandate without having to add residents, the authors pointed out the real possibility of quality of education and time off between shifts undergoing further erosion.
Paul Rockey’s editorial pointed out the poor quality of evidence, which has been used to justify and measure the effects of the substantial changes in resident duty hours that have been instituted since 1989. He suggested that we ”…step back, take a deep breath, and wait until better evidence becomes available.” It appears that for the majority of residency program directors in this country, this suggestion is indeed a breath of fresh air.
– Norman A. Johanson, MD
Orthopedic department chair
Director of the orthopedic surgery residency program
Drexel University College of Medicine
Philadelphia
Disclosure: He has no relevant financial disclosures.
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