Letter Advocating Reduction of Resident Work Hours
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.
Sincerely,
Helen Haskell
Founder and President
Mothers Against Medical Error
155 South Bull Street
Columbia, South Carolina 29205
www.mamemomsonline.org
Sidney Wolfe, M.D.
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