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Residents to work fewer hours

BY MADISON BENNETT | MARCH 10, 2011 7:20 AM

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Physicians aren’t the only ones who can make mistakes when they’re tired. But the profession is one of the few where mistakes can cost lives.

In an effort to prevent those errors, the Accreditation Council for Graduate Medical Education has mandated first-year residents work no longer than 16 hours straight. The restrictions will go into effect nationwide July 1.

As it stands now, residents are restricted from working more than 80 hours per week and must take four days off over the course of a month. They can’t work more than 24 hours during a single shift and must leave the hospital within six hours of ending their day.

Though some lauded the changes, others said they’re concerned the move could diminish learning opportunities for medical residents.

“One of the things that it may affect is the range of experiences physicians can get during the resident training program,” said Mark Wilson, the director of graduate medical education at the University of Iowa Hospitals and Clinics.

Chris Hogrefe, a third-year emergency-medicine resident at the UI, said 24-hour shifts are important to the learning process.

“A lot of the learning opportunities I got were because I was the only person there,” he said. “There’s a lot to be said for that.”

Justin Smock, the chief resident in Internal Medicine at the UIHC, agreed.

“I learned many things about being a physician in the middle of the night,” he said.

But Smock said he’s not worried the experience will be diminished. He said his department will have just as many residents, but they’ll have different starting times.

Lyndsay Harshman, a UI medical student who will be a first-year resident in July, said she worries about the loss of the 24-hour shift.

“Hands-on emergent learning could be lost a little bit,” she said. “But I’m hoping that programs across the country are finding a way to compensate.”

Genesis Health System in the Quad Cities adopted the changes Jan. 1, media-relations coordinator Craig Cooper said.

“What the changes do is shift more of the responsibilities away from first-year residents to upper-level residents,” said Andrew Andresen, executive director of Genesis Quad Cities Family Medicine Residency.

He said he prefers the maximum 16-hour shifts and would like residents to work even fewer hours.

But the system may cause some problems.

Wilson said the restrictions may make scheduling among faculty, patients, and residents more difficult. And the change may increase the number of times a single patient is handed off to a different doctor.

“Each time a patient is handed off, there is increased potential risk for mistakes to be made,” Wilson said, noting there’s no way of knowing if this risk is as great as working long shifts.

Whenever any physician is sleep deprived, the physician can become less effective, which leads to mistakes as simple as medication orders errors, Wilson said.

“There’s general agreement that working 120 hours a week was not ideal both for patient care and for physician training,” Wilson said.


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