medical students, medical training

Medical Residents’ Shifts Could Include Sleep Periods

December 04, 2008 08:58 AM
by Emily Coakley
An Institute of Medicine report suggests allowing naps during residents’ shifts, however it’s unclear whether the recommendations will be adopted.

Report Says Fatigue Impairs Doctor Performance

An Institute of Medicine report recommends naps for residents, one of many changes suggested for hospitals in an effort to decrease physician errors and accidents.

“Our overarching conclusion is that the science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off,” said Dr. Michael M.E. Johns, chairman of the committee that wrote the report, the Boston Globe reported.

Other recommendations include better communication when patients are handed off to another doctor during shift changes, and limiting the length of shifts.

Approximately two years ago, Summa Health System in Akron limited residents’ shifts to 16 hours, the Akron Beacon Journal reported. To ensure their training did not suffer, the hospital made some changes, such as having residents start later in the day, when more patients are admitted.

“Our residents get the same volume of patient experience as they did before, but they're not here as long. They're not rushed. They're not tired because they've been up for 24 to 30 hours at a time,” Dr. David Sweet, director of the internal medicine residency program at Summa, told the Beacon Journal.

According to the Globe, putting the Institute’s recommendations into practice could cost $1.7 billion, mostly because hospitals would have to pay staff while residents sleep. It’s not clear, the paper said, what action the Accreditation Council for Graduate Medical Education might take on the recommendations.

Currently, the council says residents “can work an average of 80 hours per week over four weeks and no more than 30 consecutive hours at a time,” the Globe wrote.

The recommendations call for a maximum shift of 16 hours or a 30-hour shift that includes a five-hour nap.

Background: Libby Zion law and changes to medical student training

The conditions under which residents are trained came into the national spotlight after the 1984 death of Libby Zion, an 18-year-old who died after being treated at New York Hospital. Her death resulted in changes to how the state regulates doctors-in-training, wrote the New York Times.

In 1995, a jury found that Zion’s death wasn’t due to the hospital or its training system, the New York Times reported. Jurors said Zion herself and three of the four doctors treating her were partly responsible for her death.

Opinion & Analysis: Prohibiting moonlighting

Commenting on the recommendations on the blog DB’s Medical Rants, a writer named Rcentor predicted that limiting other jobs residents could have, also known as moonlighting, might not be popular.    

“We saddle our students with unreasonable debts, and then we will handicap their ability to make some extra money during residency.  I remember the importance of moonlighting money in buying my first house and a new car.  I see residents moonlight so that they can have some semblance of a decent quality of life,” Rcentor wrote.

The writer also thought that though the idea of a 16-hour shift made “some sense,” the result “will put great strains on education.”

Related Topics: Bad times to be in a hospital; global doctor shortage

A study conducted by Harvard researchers and published earlier this year found July to be the most dangerous month to visit a hospital, citing the arrival of inexperienced interns.

The question of residents’ working conditions is just one of many problems facing the health industry. Around the world, countries are grappling with doctor shortages, caused by several factors, including health worker migration and an increase in female doctors, who often leave the industry. In addition, many medical students are choosing to specialize instead of becoming general practitioners.

Most Recent Beyond The Headlines