Medical Residents Can't Win

This article published with permission from The Burrill Report.

The percentage of first-year medical residents who reported concerns about making a serious medical error has risen with growing workloads, calling into question the benefits of a mandated cutback in their work hours, according to a new study.

However, despite interns’ worries, reports of actual medical errors committed by interns before and after the duty hour reform have changed little, University of Michigan researchers found. Furthermore, there has been little beneficial change in the daily hours of sleep interns get, their self-reported well-being scores and incidence of depression, according to an article published in the American Medical Association’s JAMA Internal Medicine.

Responding to concerns that residents were overworked and overly tired, the Accreditation Council for Graduate Medical Education has twice pared back the allowable duty hours for residents. In July 2011, the group limited the maximum shift length for interns to 16 hours. While the change limited lengthy work days for interns, the workload was not commensurately reduced. As a result, the percentage of interns worried about making a serious medical error actually increased from a pre-reform 19.9% to a post-reform 23.3%.

The interns working fewer hours got more sleep specifically when on call. But compared to the model allowing longer hours, they also reported deteriorations in educational opportunities, continuity of patient care and perceived quality of care, according to the authors.

A total of 2,323 medical interns from 51 residency programs at 14 university and community-based graduate medical education institutions participated in the longitudinal cohort study. The study compared interns serving before and interns serving after the implementation of the new duty hour requirements.

“Residents should no longer be asked to do an increasing amount of work in less time and with less flexibility,” write Lara Goitein and Kenneth Ludmerer, two doctors who wrote an editorial accompanying the study.

According to a national survey of medical residents, most would rather work longer hours and tolerate more sleep deprivation than jeopardize patients’ safety and their own education, they note.

“We owe better to our residents and to their patients. It is time to address the disease, not just the symptom,” the authors wrote.

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