I love nap time. Since internship, I am capable of power naps and long naps. As an intern and resident I often was tired, and learned to grab sleep when I could. I am in favor of resident naps, but they should not be required.
Today’s NEJM has a great editorial (it should be free but it is not) – To Nap or Not to Nap? Residents’ Work Hours Revisited. The editorial finishes:
The IOM committee urged rapid implementation of their recommendations. We strongly disagree. In this era of evidence-based medicine and comparative effectiveness, such a major policy change should be based not only on the recommendations of an expert committee but also on careful studies and evidence that improvements in both patient and educational outcomes will result. To date, the necessary research has not been done and the evidence of benefit is lacking. The introduction of new drugs and devices requires a clear understanding of efficacy and safety, and cost is increasingly also closely examined. Similar rigor should be applied to changes in policy such as these that have broad ramifications. We urge the ACGME to require that studies be conducted to answer key questions: What is the impact on preventable adverse events and costs? How can patient handoffs be achieved safely? How are educational and professional standards maintained when residents work in short blocks of time? Should handoffs be delayed during medical emergencies? Will reduced workloads undermine residents’ preparation for independent clinical practice? These questions must be addressed in different specialties, hospital settings, and regions of the country. The answers should guide the ACGME decision on whether or not to implement the IOM recommendations.
The entire editorial is spot on. Rigid rules on work hours are really damaging housestaff education. I agree with general rules, with the understanding the residents have the right to break the rules for ethical and eduational reasons. Residents need protection from abusive programs, but rigid bureaucratic rules are never the answer.
As the writers discuss, we need data on the potential impact of these rules before we change a training system that has served our profession well for many years. Methinks the committees have worried too much about the public perception of work hour rules and have abandoned concerns about adequate training. What do we trade if our residents do not get enough experience? Perhaps your future care will suffer.
