The Association of Pediatric Program Directors’ (APPD) leadership and members have
given significant thought to the Institute of Medicine Committee’s recommendations
1
and to the recent Accreditation Council for Graduate Medical Education’s (ACGME)
proposed changes to the “Common Program Requirements” written by the ACGME Duty Hours
Task Force.
2
As expressed through the series of 5 APPD action calls in July and August 2010, members
wholeheartedly concurred with most principles of the document, which is clearly aimed
at improving supervision, enhancing professional formation with an emphasis on personal
responsibility, and ensuring patient safety.
3
We were, however, highly concerned with a number of areas that we strongly believe
should be rewritten, modified, or not implemented at all.
In addition, the APPD believes it is critically important that there be careful study
and analysis of any changes that are implemented. Studying outcomes is essential because
there is limited evidence to describe any improvement in resident education, trainee
work–life balance, or patient safety after the implementation of the 2003 duty hours
requirements.
5
The changes proposed by the ACGME are significant and will result in unprecedented
large and complex alterations of patient care delivery systems. Current evidence supports
that elective changes of this magnitude should not be done without careful, site-specific
piloting, analysis, and follow-up with reflection and appropriate modifications to
those changes in a Plan-Do-Study-Act fashion.
6
,
7
,
8
,
9
Detailed reports of quality improvement studies would inform the ACGME and the public
about the relative risk of resident work hours in a well-supervised and continuous
team structure versus discontinuity and increased patient care handovers. We implore
the ACGME to measure, analyze, and evaluate outcomes of this change. It is absolutely
necessary to provide the community with evidence-based recommendations about how to
structure patient care teams within graduate medical education programs to achieve
high-quality, safe patient care while developing exemplary physicians.To read this article in full you will need to make a payment
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References
- Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.National Academy of Sciences, Washington, DC2009
- Proposed Standards.(Available at:) (Accessed September 1, 2010)
- The new recommendations on duty hours from the ACGME task force.N Engl J Med. 2010; E3: 1-6
- (Available at:) (Accessed September 4, 2010)
- New requirements for resident duty hours.J Am Med Assoc. 2002; 288: 1112-1114
- Planning for change: medical education program design, patient care, and measures of effectiveness.Acad Pediatr. 2009; 9: 67-68
- Understanding medical error and improving patient safety in the inpatient setting.Med Clin North Am. 2002; 86: 847-867
- The impact of a regulation restricting medical housestaff working hours on the quality of patient care.JAMA. 1993; 269: 374-378
- The impact of a night float system on internal medicine programs.Int J Gen Med. 1993; 269: 374-378
- The Reflective Practitioner. How Professionals Think in Action.Temple Smith, London1983
- Promoting reflection on professionalism: acomparison trial of educational interventions for medical students.Acad Med. 2003; 78: 742-747
- Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs.Acad Med. 2005; 80: 1094-1099
- Patient handoffs: the pitfalls and solutions of transferring patients safely from one caregiver to another.Hosp Health Netw. 2008; 82: 41-48
- A structured handoff program for interns.Acad Med. 2009; 84: 347-352
- Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey.Qual Saf Health Care. 2008; 17: 6-10
Accreditation Council for Graduate Medical Education. Proposed Common Requirements. Available at: http://acgme-2010standards.org/pdf/Proposed_Standards.pdf. Accessed September 11, 2010. Requirement: VI.B.1.
- Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.National Academy of Sciences, Washington, DC2009 (296)
- Letter to program directors, designated officials, members of the faculty, residents, and fellows.(Available at:) (Accessed September 9, 2010)
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© 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
