Hot off the press!
The Accreditation Council for Graduate Medical Education (ACGME) recently released the final version of guidelines relating to duty hours and supervision standards. These changes will affect 110,000 residents within the ACGME's 8,800 accredited residency programs in 133 specialties and subspecialties. Providing an exceptional graduate medical education as well as ensuring patient safety were highlighted goals.Some of the prior standards:
- A duty hour limit of 80 hours per week.
- Requirements in the levels of supervision for first-year residents.
- A work day of 16 hours or less for first-year residents.
- Establishing graduated requirements for minimum time off between scheduled duty periods. For instance: "Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested."
- Expanding program and institutional requirements regarding handovers of patient care.
- Setting more specific requirements for alertness management and fatigue mitigation strategies designed to ensure both continuity of patient care and resident safety.
What are your thoughts on duty hours
and supervision standards???
For similiar blog discussions of duty-hours, based on the Institute of Medicine 2008 recommendations and their relevance to EM.
Hey Fred: I think most of the overarching recommendations to further limit duty hours are going to impact services which have traditional call rotations (Surgery, Medicine). Trying to fit in a "nap gap" after 16 hours of continuous, while ideal, would be virtually impossible to schedule ahead of time in the unpredictable world of medicine. What WILL impact EM residents is that off-service departments may pull their residents back into their "home" department to fill in coverage. This leave the ED, often covered to some extent by off-service residents, short-staffed. It will be interesting to see what shakes out.
ReplyDeleteDo you think the restrictions will make new residents less "tough" or "resilient"? Once any specialist enters community practice, you undoubtedly will have long, enduring days having to manage critical patients while fatigued. Is it bad/good to have never experienced this while training before doing it on your own?
ReplyDeleteA nap during the day? Interesting how that would pan out. Maybe we could get nap pods like Google (http://blogs.techrepublic.com.com/geekend/?p=1231)?
Are the current rules enforced for on-call residents? When I trained on the East Coast, faculty were constantly watching the clock so that the on-call residents didn't stay over. A friend of mine who trained in IM on the West Coast said that the rules were NEVER followed and that residents were constantly over the time limits.
Anyone else have thoughts?