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Resident Work Duty Hour Requirements: Medical Educators’ Perspectives

  • Ann E. Burke
    Correspondence
    Address correspondence to Ann E. Burke, MD, Dayton Children’s Medical Center, Medical Education Department, One Children’s Plaza, Dayton, Ohio 45419.
    Affiliations
    Association of Pediatric Program Directors (Drs Burke, Rushton, Guralnick, Hicks); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind (Dr Rushton); Winthrop University Hospital, Mineola, NY (Dr Guralnick); and The Children’s Hospital of Philadelphia, Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pa (Dr Hicks)
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  • Jerry Rushton
    Affiliations
    Association of Pediatric Program Directors (Drs Burke, Rushton, Guralnick, Hicks); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind (Dr Rushton); Winthrop University Hospital, Mineola, NY (Dr Guralnick); and The Children’s Hospital of Philadelphia, Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pa (Dr Hicks)
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  • Susan Guralnick
    Affiliations
    Association of Pediatric Program Directors (Drs Burke, Rushton, Guralnick, Hicks); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind (Dr Rushton); Winthrop University Hospital, Mineola, NY (Dr Guralnick); and The Children’s Hospital of Philadelphia, Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pa (Dr Hicks)
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  • Patricia Hicks
    Affiliations
    Association of Pediatric Program Directors (Drs Burke, Rushton, Guralnick, Hicks); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind (Dr Rushton); Winthrop University Hospital, Mineola, NY (Dr Guralnick); and The Children’s Hospital of Philadelphia, Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pa (Dr Hicks)
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      The Association of Pediatric Program Directors’ (APPD) leadership and members have given significant thought to the Institute of Medicine Committee’s recommendations
      • Ulmer C.
      • Wolman D.M.
      • Johns M.M.E.
      Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
      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.
      • Accreditation Council for Graduate Medical Education
      Proposed Standards.
      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.
      • Nasca T.J.
      • Day S.H.
      • Amis E.S.
      The new recommendations on duty hours from the ACGME task force.
      We were, however, highly concerned with a number of areas that we strongly believe should be rewritten, modified, or not implemented at all.
      • Association of Pediatric Program Directors
      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.
      • Philibert I.
      • Freidman P.
      • Williams W.T.
      New requirements for resident duty hours.
      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.
      • Hicks P.J.
      Planning for change: medical education program design, patient care, and measures of effectiveness.
      • Shojania K.G.
      • Wald H.
      • Gross R.
      Understanding medical error and improving patient safety in the inpatient setting.
      • Laine C.
      • Golman L.
      • Soukup J.R.
      • Hayes J.G.
      The impact of a regulation restricting medical housestaff working hours on the quality of patient care.
      • Trontell M.D.
      • Carson J.L.
      • Taragin M.I.
      • Duff A.
      The impact of a night float system on internal medicine programs.
      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.
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      References

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        • Wolman D.M.
        • Johns M.M.E.
        Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
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        Proposed Standards.
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        Planning for change: medical education program design, patient care, and measures of effectiveness.
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        Understanding medical error and improving patient safety in the inpatient setting.
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      1. 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.

        • Ulmer C.
        • Wolman D.M.
        • Johns M.M.E.
        Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
        National Academy of Sciences, Washington, DC2009 (296)
        • Nasca T.J.
        Letter to program directors, designated officials, members of the faculty, residents, and fellows.
        (Available at:) (Accessed September 9, 2010)