Public Citizen | Publications - Open Letter to Executive Director of the Accreditation Council of Graduate Medical Education (ACGME) (HRG Publication #1901)

Open Letter to Executive Director of the Accreditation Council of Graduate Medical Education (ACGME) (HRG Publication #1901)

February 4, 2010

Thomas J. Nasca, M.D.
Executive Director
Accreditation Council for Graduate Medical Education
515 State St. #2000
Chicago, IL 60654

cc. Rep. Henry A. Waxman, Chair, House Energy & Commerce Committee.

RE: Optimizing Medical Resident Schedules to Improve Patient Safety

Dear Dr. Nasca:

In December 2008, the Institute of Medicine (IOM) released its 
landmark report, Resident Duty Hours: Enhancing Sleep, Supervision, 
and Safety
, the most comprehensive study of resident work hours 
conducted to date.  The study reviews the robust evidence base 
linking fatigue with decreased performance in both research 
laboratory and clinical settings and makes a number of important 
recommendations for changes in the current system of training 
physicians. These include new limits on resident physician work 
hours and work load, increased supervision, training in structured 
hand-overs and quality improvement systems, more rigorous oversight 
and the identification of expanded funding sources necessary to 
successfully implement the recommended reforms.

In response to the release of this report, we understand that the 
ACGME formed a Duty Hours Task Force and charged it with 
recommending revisions to the current duty hour and supervision 
standards. We are concerned, however, that the ACGME is not 
adequately weighing the concerns of patients in its deliberations.

Indeed, the available evidence suggests that the public is deeply 
concerned about the current work hours of medical residents. In a 
2002 national public opinion poll conducted by the National Sleep 
Foundation, 70 percent of respondents reported that they were 
“somewhat likely” or “very likely” to request another doctor if 
they learned that their doctor had been working for 24 hours 
consecutively. Additionally, in a 2004 Kaiser Family Foundation 
public opinion poll, 74 percent of respondents listed “stress, 
overwork, or fatigue of health professionals” as a “very important 
cause of medical errors” and 66 percent agreed that reducing the 
work hours of doctors to avoid fatigue would be a “very effective” 
way to reduce medical errors.

We strongly urge the ACGME to make patient safety a central focus 
of its response to the IOM’s recommendations. There is no 
scientific evidence to support the idea that a responsibly 
implemented reduction in working hours as contemplated by the IOM 
will limit educational opportunities or otherwise leave residents 
less prepared to practice medicine. Rather, there is abundant 
evidence showing that the ability of human beings to learn and to 
perform tasks is compromised by fatigue. Resident physicians are 
not immune to these universal physiological responses. The IOM 
recommendations limiting resident hours and workload, training 
residents in effective techniques for transferring patient 
information and improving supervision will, we believe, improve 
patient safety in the nation’s teaching hospitals.

Given press reports over the past year highlighting the academic 
medical community’s criticisms of the IOM recommendations as well 
as information on the ACGME website (Open Letter to the GME 
Community from Thomas J. Nasca, M.D., MACP, 10/28/09), we are fearful 
that the ACGME will choose not to adequately act on the evidence at 
this critical juncture.  It is our belief that the ACGME’s 
commitment to quality patient care and resident education should, 
at a minimum, result in prompt adoption of the IOM recommendations.


Helen Haskell
Founder and President
Mothers Against Medical Error
155 South Bull Street
Columbia, South Carolina 29205

Sidney Wolfe, M.D., Director
Alan Levine, Health Care Researcher
Public Citizen Health Research Group
1600 20th Street, NW
Washington, DC 20009

Ilene Corina
P.O. Box 353
Wantagh, NY 11793-0353

Arthur Aaron Levin M.P.H.
Center for Medical Consumers
239 Thompson Street
New York, NY 10012 

Sorrel King
President and Co-Founder
The Josie King Foundation
Baltimore, MD 

David A. Swankin, Esq.
President and CEO
Citizen Advocacy Center (CAC)
1400 16th Street NW Suite 101
Washington, DC 20036

Lisa McGiffert
Campaign Manager
Safe Patient Project
Consumers Union
506 West 14th Street, Suite A
Austin, TX 78701

Julia Hallisy
The Empowered Patient Coalition
595 Buckingham Way, Suite 305
San Francisco, CA 94132

Ken Farbstein
Consumer Health Quality Council
Health Care for All Massachusetts
Cambridge, MA

Dale Ann Micalizzi
Founder and Director
Justin's HOPE at
The Task Force For Global Health
136 Bogusky Ct.
Schenectady, NY 12306 

Jean Rexford
Executive Director
CT Center for Patient Safety
26 West Woodland Drive
Redding CT 06896

Susan Sheridan, MIM, M.B.A
Mitchell L. Dvorak, M.S., CAE
Executive Director
Consumers Advancing Patient Safety (CAPS)
405 N. Wabash Avenue, Suite P2W
Chicago, IL 60611 

Jeanine Thomas
Founder and President
MRSA Survivors Network
P.O. Box 241
Hinsdale, IL 60521

Karen Dixon, Ph.D.
Parents of Infants and Children with Kernicterus (PICK)
405 N. Wabash, Ste. P2W
Chicago, IL 60611

Lenore Janecek
Founder and President
Save The Patient
260 E. Chestnut, #1712
Chicago, IL 60611 

Blair Horner
Legislative Director
New York Public Interest Research Group
107 Washington Avenue
Albany NY, 12210 

Ted Zimmer
Consumer Health Coalition
650 Smithfield Street
Pittsburgh, PA 15222-3912

Jennifer Dingman
Founder, PULSE of Colorado
Co-Founder, PULSE of America
Founder, Pulse of America Coalition for Healthcare Reform
5249 Manor Brier Ct.
Pueblo, CO 81005 

Roberta Mikles, R.N. B.A.
Patient Safety Advocate
San Diego, CA

Martin J. Hatlie, J.D.
Partnership for Patient Safety
405 N. Wabash P2W
Chicago, IL 60611 

Trisha Torrey
DiagKNOWsis Family of Patient Services
P.O. Box 53
Baldwinsville, NY 13027

Regina Holliday
Muralist and Activist
Medical Advocacy Mural Project
Washington, DC 

Becky Martins
P.O. Box 273
Warren, ME 04864 

Karen Aydt Curtiss
736 North Western Avenue, #326
Lake Forest, IL 60045

Lori Nerbonne, R.N., B.S.N.
NH Patient Voices
6 Fieldstone Drive
Bow, NH 03304

Carol Weihrer
President & Founder
Anesthesia Awareness Campaign, Inc.
1658 Parkcrest Circle #200
Reston, VA 20190-4946 

Martine Ehrenclou, M.A.
Author, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive
1158 26th Street, Suite #502
Santa Monica, CA 90403

Patty Skolnik
Founder and Executive Director
Citizens for Patient Safety
801 Yosemite St.
Denver, CO 80230

Kevin Kavanagh, M.D.
Health Watch USA
3396 Woodhaven Dr
Somerset, KY 42503

Kim Witczak
345 North 6th Avenue, #102
Minneapolis, MN 55401

Jan S. Vick
Executive Director
SC Voices for Patient Safety
P.O. Box 776,
Chesterfield, SC 29709 

Pat Mastors
The Empowered Patient
East Greenwich, RI

John T. James
Patient Safety America
14503 Windy Ridge Lane
Houston, TX 77062

Bart Windrum
President and Presenter
Axiom Action
Author, Notes from the Waiting Room: Managing a Loved One's End of Life Hospitalization
3855 Telluride Place
Boulder, CO 80305-7219

John C. Ruoff, Ph.D.
Program Director
South Carolina Fair Share
P.O. Box 8888
2001 Assembly St., Ste. 107
Columbia, SC 29202

Harvey S. Frey M.D. Ph.D. Esq.
Health Administration Responsibility Project
Santa Monica, CA

Mary Ellen Mannix, MRPE
Founder and President
The STB Project 
618 Kirsch Ave
Wayne, PA 19087

Patti O'Regan, DNP(c), ARNP, ANP, NP-C, PMHNP-BC
Board Certified Nurse Practitioner
Adult Primary Care & Psychiatry
Founder and Committee Chair,
World, Global, National Patient Safety Day
Tampa Bay Area, Florida 

DK Raymer
Healthcare PSI
2733 E. Battlefield #272
Springfield, MO 65804

Bonnie Getz
Fight Staph Infections Inc.
624 Station West Lane
Roebuck, SC 29376

Lisa Lindell
Author and Coordinator
Texas Coordinator, PULSE of America
P.O. Box 57491
Webster TX 77598

Doug Hall
PULSE of Florida
Palm Harbor, FL 

Alicia Cole
HAI Survivor and Founder
Alliance for Safety Awareness for Patients
14622 Ventura Blvd., #102-827
Sherman Oaks, CA 91413