One of the first hot issues on Medrants (over 6 years ago) was the change in residency work hours.  Recently the IOM has had a committee looking further at this issue.  The report is out with some surprises and some new problems.  Expert Panel Seeks Changes in Training of Medical Residents

The experts’ report, issued by the Institute of Medicine on Tuesday, focused on the grueling training of medical residents, the recent medical school graduates who care for patients under the supervision of a fully licensed physician. The medical residency, which aims to educate doctors by immersing them in a particular specialty and all aspects of patient care, is characterized by heavy workloads, 80-hour workweeks and sleep deprivation.

So the author paints residency as “grueling.”  As usual they focus on sleep deprivation.  As usual they do not ask if current training produces well trained physicians.

So of course the panel has solutions to the problem they declare.

But the expert panel said those reforms were not enough. Caps on work hours are often not enforced, and many residents still do not get enough sleep, putting doctors and patients at risk for fatigue-related mistakes. While the new recommendations do not reduce overall working hours for residents, the report says no resident should work longer than a 16-hour shift, which should be followed by a mandatory five-hour nap period.

The committee also called for better supervision of the doctors-in-training; prohibitions against moonlighting, or working extra jobs; mandatory days off each month; and assigning chores like drawing blood to other hospital workers so residents have more time for patient care.

The idea of 16 hour shifts makes some sense, but it will put great strains on education.  The mandatory 4 days off each month (recommended to increase to 5 for unknown reasons) has a serious untended consequence.  When making rounds daily with a team, often I am the only person providing continuity.  When I give “chalk talks” someone is always absent.

Now I do understand the need for days off.  I do believe in sleep.  However, we must understand that changing these rules often have negative impacts on education.  We have residents who cannot attend noon conference because their “shift” is over.  How does that help the resident?

I suspect that many residents will balk about the moonlighting rules.  We saddle our students with unreasonable debts, and then we will handicap their ability to make some extra money during residency.  I remember the importance of moonlighting money in buying my first house and a new car.  I see residents moonlight so that they can have some semblance of a decent quality of life.

The 16 hour shift will stretch our ability to provide good education.

On the positive side, the committee did not back off from the 80 hours.  They recommend more strenuous enforcement, and I agree with that plan.  I do hope that they do not penalize residents and programs when the infractions are totally voluntary and associated with educational desires.

More on this subject as others comment.