New Residency Guidelines

[TheFlashMD]

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Apparently, new interns having worked 16 hours get naptime .

http://www.nytimes.com/2010/06/24/health/24chen.html?ref=health

 

[Disinence2]

Very Interesting.. July 2011 sounds like a good time for these to go into effect.

Some of the residency programs around here have been experimenting with "Required" Naps during call. I have a feeling that the logistics of implementing this will be a huge problem with a good chunk of residency programs...

It will be interesting to see what happens...

 

[Law2Doc]

Very Interesting.. July 2011 sounds like a good time for these to go into effect.

Some of the residency programs around here have been experimenting with "Required" Naps during call. I have a feeling that the logistics of implementing this will be a huge problem with a good chunk of residency programs...

It will be interesting to see what happens...

Yeah, from what I can tell nobody is in a big rush for this to happen. This is merely a set of recommendations, some better than others. Odds of this proposal happening 100% as written are close to nil, IMHO.

 

[morning]

Has restricting work hours in the UK for junior doctors reduced mortality at all? I thought I read that it hadn't, but it hadn't made things any worse when they enter the workforce as full doctors, either. I might be wrong there.

Not that I'm a resident, but one would think if they reduced the amount of paperwork residents have to do, they could work less hours and still get the same amount of clinical training.

 

[TexasPhysician]

I'm actually enjoying intern year thus far. Maybe when I'm post-call I'll say otherwise, but usually I pretty darn happy. It isn't that bad if you enjoy what you do.

 

[Law2Doc]

Has restricting work hours in the UK for junior doctors reduced mortality at all? I thought I read that it hadn't, but it hadn't made things any worse when they enter the workforce as full doctors, either. I might be wrong there.

Not that I'm a resident, but one would think if they reduced the amount of paperwork residents have to do, they could work less hours and still get the same amount of clinical training.

From what I've read, it hasn't made much difference in mortality of patients, although studies in the US after the 80 hour work rules suggest there have been fewer resident caused traffic accidents after the change.

People like to throw around notions like -- if they could only reduce the paperwork, reduce the scut, then you could work less hours. But you will see when you get here that the paperwork and scut is part and parcel of the training, and there really isn't as much true "scut" as you might think. Being a doctor in this era involves doing a lot of paperwork. You aren't going to be able to simply talk to and treat patients and hand off the dictations, chart notes and paperwork to others. That's not realistic. And if you don't document what you do, you are opening yourself up to lawsuits. It is NECESSARY that the person providing the care does much of the documentation.

And not learning how to work up a patient from admission to discharge, including the related paperwork, means you won't be usefully trained. Because honestly, as a resident you do a heck of a lot less paperwork than you will in private practice. Because we don't really focus on what needs to be done to get paid, we focus on what needs to get done to move the patient through their hospital stay. A lot of the "real" paperwork is already done behind the scenes, between the hospital billing offices and the insurance companies. When you finish residency, you won't be insulated from this stuff.

So no, the answer isn't "just eliminate the scut". The job encompasses the scut by necessity. The answer is to find a happy balance between doing and seeing a lot, and not getting enough rest. The 80 hour requirement, when actually enforced, is a big improvement from the perspective of residents. But it hasn't created the windfall of decreasing mistakes, because it has increased the number of handoffs required, which tends to be where a lot of the errors creep into the system. Keeping the hours at 80 and squeezing in naps and restricting numbers of days in a row of night float doesn't really make many of the problems with the system better IMHO.

 

[Hoody]

naptime? residents these days are such sissys. 🙄

 

[Law2Doc]

I'm actually enjoying intern year thus far. Maybe when I'm post-call I'll say otherwise, but usually I pretty darn happy. It isn't that bad if you enjoy what you do.

Agreed. It's a lot of hours and precludes a lot of outside activities/social life. But the day to day work can be a blast at a benign program.

 

[Perrotfish]

Yeah, from what I can tell nobody is in a big rush for this to happen. This is merely a set of recommendations, some better than others. Odds of this proposal happening 100% as written are close to nil, IMHO.

What makes you say this? This is a research committee internal to the group that accredits residecies. It's not like all residecy directors get to take a vote on whether or not to implement the policy, it just goes before the ACGME board in a few weeks. Why wouldn't the ACGME listen to their own taskforce?

Also, BTW, did anyone else notice that the new standards kill moonlighting? Interns can't moonlight at all and other residents have to count the hours towards their 80 hour cap.

Has restricting work hours in the UK for junior doctors reduced mortality at all? I thought I read that it hadn't, but it hadn't made things any worse when they enter the workforce as full doctors, either. I might be wrong there.

Has it made mortality any worse? There are reasons beyond my patients' safety that I want to be allowed to sleep at night.

 

[morning]

Reading in the residency forum about this since it seemed more appropriate than the pre-med forum, and it seems like people think this is all hot air and will do nothing but muddy the waters:

http://forums.studentdoctor.net/showthread.php?t=726892

Has it made mortality any worse? There are reasons beyond my patients' safety that I want to be allowed to sleep at night.

That's really beyond my scope of experience to talk about. However, I do know that your patients agree with you. The last time I was reading about this stuff, there was a new survey out showing that patients would not choose to go to a doctor who had been up 30 hours and would prefer to be told if that was the case. Etc.

 

[Gabby]

Also, BTW, did anyone else notice that the new standards kill moonlighting? Interns can't moonlight at all and other residents have to count the hours towards their 80 hour cap.

I didn't think interns could moonlight now. They're not fully licensed yet.

Has it made mortality any worse? There are reasons beyond my patients' safety that I want to be allowed to sleep at night.

I'm with you on that! I hate that people act like the only reason that residency hours should be reduced is patient safety. How about physician health? Why isn't that part of the argument?

 

[Perrotfish]

I didn't think interns could moonlight now. They're not fully licensed yet.

My understand, could be wrong as I'm still in med school:

To moonlight as an intern you need to moonlight within the same system you're doing residency at. This restricts your options since 1) you can't go down the road to an urgent care facility if they don't have an opening and 2) intenal moonlighting already counts towards the 80 hour cap. However people do still manage to do it.

 

[Hoody]

I didn't think interns could moonlight now. They're not fully licensed yet.

They aren't allowed to at my hospital. Only chief residents from certain programs can moonlight. everyone else has to be beyond residency. the moonlighters come from all over (other states, hospitals, schools, etc).


I did however try to consult with another hospital recently, early early in the morning, and was told that my attending would be able to speak to one of their interns or residents. so they made it seem like only interns and residents were around at night. they basically refused to connect me to an attending ("you can call him in the morning'). Well, yes, my attending would LOVE to speak to your intern.

 

[TheFlashMD]

Yeah, from what I can tell nobody is in a big rush for this to happen. This is merely a set of recommendations, some better than others. Odds of this proposal happening 100% as written are close to nil, IMHO.

Not saying you're wrong, but at least the article seems to indicate they're pretty serious.

The recommendations are now up for public review; but the accreditation council plans to proceed with putting these newer, more stringent standards into effect in July 2011. And plans are under way for the organization to begin visiting every one of its nearly 9,000 accredited institutions every year, rather than fewer than a quarter of them, as it does today, in order to ensure the strictest compliance throughout the country with the newest guidelines. All findings will then be made public.
While the annual site visits will cost each institution an additional $12,000 to $15,000 dollars each year, Dr. Nasca said that "it’s a relatively small price to pay to demonstrate to the public that we are serious about the standards and compliance with these standards."

 

[Gabby]

Not saying you're wrong, but at least the article seems to indicate they're pretty serious.

I tend to agree. They seem pretty serious about these changes.

 

[TexasPhysician]

My understand, could be wrong as I'm still in med school:

To moonlight as an intern you need to moonlight within the same system you're doing residency at. This restricts your options since 1) you can't go down the road to an urgent care facility if they don't have an opening and 2) intenal moonlighting already counts towards the 80 hour cap. However people do still manage to do it.

Correct. It is "possible" to moonlight as an intern, but very improbable since most programs don't allow it or restrict internal moonlighting to upper years. I only know of 1 program currently doing so.