New rules aimed at reducing errors by sleep-deprived medical residents could backfire by depriving those trainees of sufficient on-the-job training, according to the findings of a study published this month by the Mayo Clinic.
As a result, many medical educators fear that patient safety could be compromised even more by the work-hour limits, the article, published in the March issue of Mayo Clinic Proceedings, reports.
At issue are changes approved by the Accreditation Council for Graduate Medical Education and scheduled to take effect by July that would prohibit first-year residents from working hospital shifts of longer than 16 hours. (Residents are doctors in training who work under a senior physician's supervision, and they can now work up to 24 hours straight.)
Residents are generally limited to working 80 hours a week—averaged over four weeks—but it's the 16-hour shift limit that is now under the microscope.
The accreditation council made the change largely on the basis of a 2008 report by the Institute of Medicine, an arm of the National Academies, that found that sleepy residents caused widespread medical errors.
But the Mayo Clinic survey results show a strong concern among medical educators that shift limits could pose their own dangers.
Nearly 500 directors of residency programs in surgery, internal medicine, and pediatrics responded to the clinic's survey. About 78 percent said forcing residents to clock out after 16 hours would compromise trainees' competency in several areas the accreditation council has defined as important: patient care, medical knowledge, interpersonal and communication skills, and professionalism.
The directors of residencies in surgery expressed the most concern about the effects of cutting into their trainees' schedules because of the number of supervised procedures residents need to perform to become technically competent.
Sonia Lazreg, a health-justice fellow at the American Medical Student Association, says her group still strongly favors the shift limits.
"When evidence shows us that people who are awake that long perform worse than people who are drunk, we have a problem," says Ms. Lazreg, who is also a student at Mount Sinai School of Medicine.
Residents could learn just as much in a 16-hour shift if noneducational "grunt work" like answering phones or transporting patients was cut back, she says.
But compressing the same amount of work into a shorter shift could result in a more intense, and ultimately more tiring work day, says Darcy A. Reed, an internist at the Mayo Clinic and the senior author of the report.
She says respondents also worry that shorter shifts could compromise continuity of care. "As residents face more handoff of responsibilities within a 24-hour period, they have less opportunity to see and learn how patients' care progresses."
No one from the accreditation council was immediately available to comment, but the highlights of the new standards are outlined on the council's Web site.
