Friday, June 24, 2011

Resident Work Hours: Let's Get Real

Today Reuters featured yet another paper that concluded that residents work hours are too long and although first-year trainees are now limited to 16 hour shifts, that may not be “… enough to prevent an alarming number of medical errors.”

The paper, which is a 39-page summary of a conference held in June of 2010, appears in the June 2011 issue of the journal Nature and Science of Sleep. The conference was held at Harvard Medical School so its conclusions must be correct. Or are they?

Let’s look at some facts.

1. The Reuters article states, “The group cited U.S. government statistics that show as many as 180,000 patients each year die due to harm resulting from their medical care.” However, the article does not cite any proof that sleep-deprived residents are causing any of these errors. There is a growing body of research [here's some] that actually shows that resident work hour reform has not had any effect on the rate of medical errors.

2. According to the European Sleep Research Society, the journal Nature and Science of Sleep has an impact factor of 0.0. That means it has no influence and is not widely read.

3. Nature and Science of Sleep is an “open-access” journal. Although its author instructions page says that it is peer-reviewed, authors must pay a fee to have their papers published. This is similar to vanity publishing.

4. Nature and Science of Sleep is not listed by any of the major medical search engines.

5. The authors of the paper estimate that curtailing resident work hours further and delegating some resident work to others would cost $1.7 billion. Who is going to pay for it?

6. Here is a little known fact that many people conveniently overlook when discussing resident working conditions. A resident who is on call for 28 consecutive hours may not necessarily be awake for all of that time. Some nights are not busy. There can be time for napping. This type of work is not analogous to long-distance bus driving or piloting an airliner both of which require long hours of uninterrupted, monotonous work.

7. I confess that I downloaded the 39-page article but couldn’t finish it due to its sleep-inducing properties. [And I wasn't even on call last night.] You are welcome to read it as I provided the link above.

5 comments:

Jeremiah said...

I am not a resident (yet). Do I look forward to 16 hour days? No. Do I think they are necessary? Absolutely. Fatigue plus stress generally forces you to become efficient and reflexive, or you flame out. I would rather go through an intense boot camp than try to gain competence over an even more protracted residency.

But then again I am not wet behind the ears after spending 8 years in school.

Kellie (General Surgeon) said...

Have the powers that be considered that it isn't work hours that is causing mistakes, but inexperience?

Curtailing hours more is clearly not the answer.

Vickie said...

It's really annoying how people don't think these through. If there is no proof that the reforms have made a difference, then why keep moving in that direction?? Who makes these decisions? What is the justification?

"Dr." G said...

I agree with your post - I do think that setting a limit on work hours was good, but now it's becoming a little excessive. I'd rather go through very difficult training, with intense hours, than come out of residency unprepared because I didn't get to see enough cases or patients. Instead of focusing so much on the hours, we should shift our attention to the amount of patients each resident is taking care of - if you have too many patients on your census, you tend to miss things more often because you feel rushed. Plain and simple.

Skeptical Scalpel said...

Good comments. Thanks. I'm glad I am not training now. Old Timer's joke: I hated working every other night because I missed half the cases!

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