Tuesday, July 20, 2010

Resident Workload Debate Unveils Bigger Picture

By Mike Martin for the AAMC Reporter
A 25-year debate over resident workloads continues to stir the medical community, as the Accreditation Council for Graduate Medical Education (ACGME) considers new standards stimulated by 2008 Institute of Medicine (IOM) recommendations.
The IOM recommendations, which include shift limitations, guaranteed sleep periods, and stricter moonlighting guidelines, have some medical professionals welcoming new ways to reduce medical errors and fatigue. At the same time, others, such as Kevin Simpson, M.D., who directs the internal medicine residency program at the Loyola University Stritch School of Medicine in Chicago, see further reductions in resident training time as unnecessary and possibly costly for hospitals covering the same patient loads with fewer available resident hours. Resident fatigue issues were at the heart of a set of 2003 ACGME standards limiting residents to 80 duty hours per week.
"The IOM report is excellent, but I disagree with the emphasis on further reducing hours," Simpson said. "Going from unlimited hours to 80 hours a week was great, but there's no need to go any further."
In a 2009 letter to the ACGME, the AAMC noted that improving how fatigue (and the residents themselves) are managed—as opposed to duty-hour limits or scheduling—is now the central issue. "We believe resident supervision and attention to patient handovers are critical but under-emphasized components of this debate," said AAMC health care affairs director Sunny Yoder. "A third important issue is resident fatigue—whatever its sources. We support the development of measures of 'fitness for duty' that could be used generally in the 24/7 health care environment." 

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