ACGME emphasizes physician well-being, patient safety in reforms

The Accreditation Council for Graduate Medical Education has released revisions to its Common Program Requirements that support a culture of patient safety and physician well-being in residency training programs by strengthening the focus on patient-centered, team-based care, according to a press release.

The group also stated that its actions mark the first time both institutions and programs are responsible for prioritizing physician well-being, ensuring protected time with patients, minimizing non-physician obligations and ensuring residents have the opportunity to access dental and medical care.

“The American public deserves to know that starting on day one physicians in practice already have the real-world experience they need to ensure high-quality patient care,” Thomas J. Nasca, MD, MACP, CEO of Accreditation Council for Graduate Medical Education (ACGME), said in the release. “Residents also have the right to develop such experience under appropriate supervision to manage the lifetime of demands and stress that come with the privilege of patient trust.”

According to ACGME, the specific changes set forth by the new standards include putting greater emphasis on patient safety and quality improvement; more thoroughly addressing physician well-being; accentuating expectations around team-based care; and developing flexibility for programs to schedule clinical and education work hours within the well-established maximums currently utilized in the United States.

The new requirements, ACGME stated, acknowledge the significant risk for depression and burnout that physicians face.

The release also stated that the total number of educational and clinical hours for residents remains the same. Residents and programs must also abide by the maximum limits averaged over 4 weeks: a maximum of 80 hours per week; 1 day of every 7 is free from clinical experience or education; in-house calls no more frequent than every third night; and no more than 24 continuous work hours for all residents. Individual specialties can make the requirements more restrictive as they deem fit.

In a separate release, AAFP’s director of medical education and liaison to the ACGME Review Committee for Family Medicine called the changes a positive first step, and that additional reviews may occur in the interest of further improving procedures.

“The success of medical training relies on the establishment of a covenant between learners and their programs and institutions,” Stan Kozakowski, MD, stated. “The goal is to provide patients with safe and high-quality health care while simultaneously seeing that physicians-in-training receive a safe and superior educational experience. These revisions will help ensure both of those outcomes.”

The AAFP also said the new requirements remove the 16-hour limit put into place for first-year residents about 5 years ago and return those residents to the 24-hour cap that had been in place across the United States for all other fellows and residents.

ACGME had conducted a periodic review of residency program requirements; then the task force reviewed published scientific literature that analyzed the impact of standards on the quality and safety of patient care, resident well-being, and resident and fellow clinical care and education hours before coming up with the proposals.

Not all medical professionals support the idea of longer duty hours. Ronald Chervin, MD, MS, president of the American Academy of Sleep Medicine and director of the University of Michigan Sleep Disorders Center, previously told Healio Family Medicine that decades of sleep and circadian science provide indisputable evidence that performance is compromised by extended wakefulness.

The revisions take effect July 1.

References:

http://www.acgme.org/Portals/0/PDFs/Nasca-Community/ACGME-Common-Press-Release-3-10-2017.pdf

http://www.aafp.org/news/education-professional-development/20170315workcap.html

Disclosure: Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.