All Entries Tagged With: "resident duty hours"
Updated crosswalk: AAMC suggests prohibiting resident moonlighting
It seems that everyone has an opinion on resident work hours. More organizations are giving their recommendations to the Accreditation Council for Graduate Medical Education (ACGME). The ACGME initiated its ground-breaking 80-hour resident workweek rules in 2003, and it has been soliciting feedback in light of the five-year anniversary in 2008. Most seem to agree on the current 80-hour rule but differ on moonlighting rules.
The Association of American Medical Colleges (AAMC) released a letter to the ACGME on April 21 with its proposed changes to resident rules. We updated our previous crosswalk to include the AAMC. Download the updated crosswalk here.
“In general, we believe that resident duty hours and schedules ultimately are not the central issue,” stated the AAMC letter. Rather, the focus should be on larger issues such as fatigue, supervision, appropriate workloads, and effectiveness of patient handoffs. “…There is very little solid evidence that links resident schedules to patient care outcomes.”
Following suit with the Institute of Medicine (IOM) and American Hospital Association (AHA), among others medical education organizations, the AAMC agrees with the ACGME current standard of a maximum of 80 hours of work, averaged over four weeks.
Crosswalk: ACGME, AHA, IOM resident work hour rules
Confused about all this talk of resident work hour changes? We compiled a crosswalk of current Accreditation Council for Graduate Medical Education (ACGME) standards and recommendations from the American Hospital Association (AHA) and the Institute of Medicine (IOM).
In 2003, the ACGME broke with tradition and adopted the ground-breaking resident 80-hour rule and promised to review it after five years. In 2007, the IOM charged the Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety to further evaluate the duty hours. In Dec. 2008, the IOM released its 500-page report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.”
The (AHA) on Monday released a statement to ACGME with recommendations for resident work hour rules. Like the ACGME and IOM, AHA supports the 80-hour cap on resident hours, averaged over four weeks.
ACGME changes resident rules in internal medicine inpatient rotations
The Accreditation Council for Graduate Medical Education (ACGME) approved changes for internal medicine residents that will take effect July 1. The major changes to inpatient rotations concern the number of internal medicine patients that a resident and supervising resident can care for.
Regarding inpatient rotations, the changes include:
Resident work rules: Boom or bust for hospitalists?
Editor’s note: Last month, we posted IOM’s proposed changes on resident sleep hours. Hear what Richard Rohr has to say about what it could mean for hospitalists.
The advent of more restrictive work rules for residents is likely to have significant, and possibly paradoxical, effects on hospital medicine. Residents would be limited to 16 hours of admitting, followed by at least 5 hours of rest, but no more admissions for the remainder of the day. This rule will likely spur further growth of night float systems within residency programs, but it could play out in other ways. [more]
Tips for effective surgical handoffs
As residents complete their 80-hour limit for the week, more doctors are changing shifts and leaving patients more vulnerable to handoff dangers. The Wall Street Journal Health Blog posted tips for surgical sign-outs between doctors, based on “The Top 10 List for a Safe and Effective Sign-out” in the October issue of Archives of Surgery. Some handoff suggestions include the following:
- Allocate time for doctors to sign out and doctors to sign in
- List important details, including patient’s surgery date and type, post-operative complications, pain management, and medications
- Design a plan to transfer patients to higher level care when necessary
- Contact the senior resident on call
- Describe the history and purpose of admission of patients to the on-call resident
