Reducing interns' hours = dangerous?
- Thread starter Geebeejay
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Surprised, but at the same time not surprised. Earlier this year I read an article from JAMA with conclusive results comparing 2011 hour restrictions vs 2003 hour restrictions which stated that increased sleep, or "break" period resulted in reduced learning opportunities, discontinuity of patient care, and a decrease in perceived quality of care.
Tl;dr - stricter hour regulations (i.e. working less, getting more sleep) actually results in lower patient care quality.
You can message me for the PDF if you are interested in the full article from JAMA, do not have weblink.
I hear more and more about how new doctors are not prepared enough because they are going through a much easier route than the older guys. I personally believe its a good idea to limit hours because it gives an unexperienced doc some time to breathe and realize what he/she is doing. The patient hand-off issues will continue to come up, significantly now with the new changes to the system but I like Vanderbilt's system where they overlap shifts. Also, training has to be difficult because it must prepare you for the real thing, and if you could accomplish a task under the worst conditions, anyother time should be simple to say the least.
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A resident I shadowed told me that he felt the 16 hour limit was actually more exhausting - In his experience, he'd just work 16 hours, go home to sleep for 8 hours, and then go right back to another 16 hour shift, as opposed to working for 30 hours and then getting a full 24 off.
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I read the study by Desai discussed in the article. One of the findings was that residents missed more didactic sessions since they were in the hospital less. Note that the residency program didn't bother to modify its delivery of didactic sessions, it just conveniently said the new system didn't work.
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Sleep is definitely a necessity- this article is just reactionary as hospitals have not adjusted their teaching methods to the new limits, as TooMuchResearch has pointed out. Sleep research shows that learning is improved with more sleep and that people who "adapt" to sleep deprivation merely believe they have adapted and make as many errors in cognition as people who feel exausted. IMO not adjusting to what research shows is foolish, particularly in a hospital.
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I feel like 24-30 hours is reasonable...but 60-hour shifts? That's ridiculous and how much can you actually learn when you haven't slept for more than two days? I completely understand that by cutting hours we are losing valuable educational time, but then why not extend residency by a year and have everyone serve as a "junior attending" or something? I do like Vanderbilt's system, though.
Also, what's the process like nowadays to report serious work-hour violations (I don't mean things like "I was forced to work 80.25 hours this week", but "they kept me here for 48 hours straight as an intern")? If we really have to report them to the people who are responsible for our recommendations (and effectively our careers) then that's still a system allowing for abuse.
Also, what's the process like nowadays to report serious work-hour violations (I don't mean things like "I was forced to work 80.25 hours this week", but "they kept me here for 48 hours straight as an intern")? If we really have to report them to the people who are responsible for our recommendations (and effectively our careers) then that's still a system allowing for abuse.
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Honestly, I feel like getting a full 24 off after being on call is better compared to simply doing 16hr shifts as an intern. Would make getting errands done a LOT easier on a weekday.
What sucks is doing OB or surgery, and not being able to stay for a delivery/case due to violating duty hours.
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Doesn't this qualify as an exception?
The Review Committee defines such
circumstances as: required continuity of care for a severely ill or
unstable patient, or a complex patient with whom the resident
has been involved; events of exceptional educational value; or,
humanistic attention to the needs of a patient or family.
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To the above, the example given to us was if one of our continuity OB patients is in labor we could file an exception with the PD who then presents that exception to the DME. It doesn't sound like it happens often, but it does sound like if it does it won't be questioned.
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Am I the only one who perceives a potential conflict of interests in the studies presented in the beginning of this article?
In my view residency directors have no desire to let go of cheap labor and are unwilling to hire additional staff to accommodate the hospitals and make it work. Not sure if its just laziness, greed, stubbornness, sense of entitlement or a combination of the above.
12-13 hours would be ideal I think. just like they did at Vandy.
In my view residency directors have no desire to let go of cheap labor and are unwilling to hire additional staff to accommodate the hospitals and make it work. Not sure if its just laziness, greed, stubbornness, sense of entitlement or a combination of the above.
12-13 hours would be ideal I think. just like they did at Vandy.
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That is a great point, which makes perfect sense. The OB continuity patient you mentioned does seem like a valid reason as well. After all, you can't just dump your panel patient to someone else cause you can't be there to catch the baby due to working 14-15-hrs.
I agree...there is nothing worse than working a 16 hour shift, then having to work another the next day on only 4-5 hours sleep. Would rather work 32 straight.
Agree, I think a lot of the issue is that so-called "senior" attendings are too stubborn and bitter to put forth a real effort to adapt their programs or teaching methods to this new system.
