The rigors of medical and surgical training require long hours dedicated to providing clinical care. While long hours are necessary to obtain the experience to eventually practice independently, performing too many hours of continuous duty promotes fatigue, which can result in medical errors, adverse patient outcomes, and risks of personal harm for trainees.
Given these concerns, in 2003 the Accreditation Council for Graduate Medical Education (ACGME), the private accrediting organization that oversees American graduate medical education programs, imposed limits for the first time on resident physician work hours. One key requirement was that resident physicians’ work shifts be limited to no more than 30 hours of continuous patient care duty. However, many patient safety advocates argued that the 2003 ACGME requirements fell short in preventing fatigue-related harms to both resident physicians and their patients.
In 2008, at the request of Congress, the Institute of Medicine (IOM) published a report outlining the increased risks of work shifts up to 30 hours in duration for trainees–including increased risks of motor vehicle accidents, exposure to blood-borne pathogens (for example, from needle sticks), and depression—and the risks to their patients as a result of medical errors. The IOM report recommended that trainee work shifts, regardless of level of training, be limited to no more than 16 consecutive hours of patient care duty, after which a protected sleep period of at least five hours was recommended. As a result, in 2011 the ACGME imposed additional restrictions to limit trainee duty hours. According to the current requirements, first-year trainees are limited to performing no more than 16 continuous duty hours; upper level residents are limited to 28-hour shifts, during which “strategic napping” is encouraged.
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