I think it's important for every med student. Work Rules Set for Medical Residents By THE ASSOCIATED PRESS Filed at 5:23 p.m. ET NEW HAVEN, Conn. (AP) -- Hoping to reduce the risk of dangerous errors by sleep-deprived doctors-in-training, an accreditation group for the nation's teaching hospitals announced new limits Wednesday on how many hours medical residents can work. The rules approved by the Accreditation Council for Graduate Medical Education are the first national limits ever put on the total number of hours that medical residents in any specialty can be on duty. Residents' work weeks will be limited to 80 hours and they must get at least 10 hours of rest between shifts. Also, they will not be allowed to be on duty for more than 24 hours straight. The new standards can be exceeded by as much as eight hours for approved educational reasons. The council retained standards set in the 1980s that say residents should get one day in seven off and should not be on call more often than one day out of three. The new rules take effect in July 2003. ``This will really require a revolution in the way residents' hours are structured,'' said Dr. Peter Herbert, chief of staff at Yale-New Haven Hospital, which was sanctioned by the council last month for overworking surgical residents. At hospitals around the country, there are often no limits on the total number of hours most medical residents can work in a week, though some specialties already impose 80-hour limits. Some doctors-in-training complain that they routinely toil more than 100 hours a week and are on call every other night. Dr. David Leach, executive director of the accreditation council, said the long, punishing hours required of medical students can lead to errors that harm patients and can undermine doctors' education, because they can become too exhausted too learn effectively. ``Residents are doing more in less time with less help,'' he said. ``We felt, in recognizing that phenomenon, we needed to strengthen our standards.'' Hospitals and doctors wondered how residents will be able to get all the training they need. They also said the rules could cost teaching hospitals millions of dollars to hire more doctors. Grueling hours have been part of doctors' training for generations, and many older doctors believe such trial-by-fire training teaches physicians to make hard decisions when they are fatigued and under pressure. In decades past, most residents followed a grueling schedule of 36 hours on and 12 hours off every two days. ``As much as it was traditional, it was not a good system,'' Herbert said. ``People have even commented on the idea that it contributes to the dehumanization of doctors in training.'' The accreditation council said the new rules are a response to changes in medicine that are putting more demands on doctors. Doctors are putting patients through batteries of tests that did not exist decades ago. At the same time, hospitals have cut back on nurses and support staff, so residents often end up doing paperwork and other mundane tasks. An 80-hour week already is standard for residents who are studying to become emergency room doctors, said Dr. J. Brian Hancock, vice president of the American College of Emergency Physicians. ``We've come a long way in realizing that the health and well-being of residents is absolutely critical to our learning process,'' he said. The council said it would act more quickly to sanction violators. The council can punish teaching hospitals by withdrawing its accreditation, a move that can cost the institutions students and millions of dollars in federal funding. The Association of American Medical Colleges endorsed the new rules and said it would urge hospitals to comply. The group said, however, it must study how much the standards will cost. The American Medical Association is scheduled to issue its own recommendations next week. The Committee of Interns and Residents, a residents union, approved of the new requirements but said they will be difficult to enforce. The group has backed legislation in Congress to put 80-hour workweeks and other resident benefits into law. ``Only a strong, enforceable federal law will protect the health of patients and resident physicians,'' said Angela Nossett, a chief resident at Harbor/UCLA Medical Center in Los Angeles. New York State already limits medical residents to 80 hours a week and no more than 24 hours at a stretch -- restrictions prompted by the death of a patient named Libby Zion in New York City 1984. Zion died at New York Hospital-Cornell Medical Center after being admitted with a high fever. A grand jury determined that long hours worked by unsupervised residents and interns contributed to her death. The council has studied the issue for a year, and had been cracking down on hospitals that violated its old standards. Last year, the council cited 18 percent of the programs it reviewed for overworking surgical residents.