A recent survey of medical residents, published in the New England Journal of Medicine, finds that newly minted doctors are divided on new work-hour rules—and many tend to view them negatively. At least one advocate of the reforms, however, questions how well residents understand the changes—or the rationale behind them.
In September, Accreditation Council for Graduate Medical Education (ACGME) approved a set of requirements that, among other provisions, preserves the 80-hour limit on the resident workweek and requires that first-year residents work no more than 16 hours continuously.
The authors surveyed residents nationwide about the likely effects of the revised standards. Twenty-three institutions in 15 states agreed to participate in the 20-question survey, the investigators report; 11,617 residents received the survey. The response rate was 22 percent.
Opinions varied, but most respondents (51 percent) indicated the changes would have a positive effect on residents' quality of life and well-being; 28 percent said it would have a negative one.
Respondents were somewhat negative on patient safety. Thirty-four percent indicated the changes would positively affect patient safety; 39 percent said patient safety would be negatively affected.
They had more negative views, however, about the impact on the quality of care delivered to patients (41 percent negative, 33 percent positive). Moreover, in their written responses, many "expressed concern about diminishing patient safety and the quality of care by increasing the number of patient handoffs and reducing the continuity of care, which the changes will necessitate in most programs," the authors wrote.
Asked about the overall effect of the proposed changes on education, far more residents anticipated a negative effect (48 percent) than a positive one (26 percent).
Specifically, they offered resoundingly negative views about the impact on residents' education, experience, and fund of knowledge (54 percent negative, 24 percent positive); and residents' preparation for more senior roles (63 percent negative, 13 percent positive).
Sonia Lazreg, a health justice fellow at American Medical Student Association, thinks that residents need more education about the body of knowledge around work hours.
"We don't know how well educated residents are" on the work hours issue, she explains, noting that there's considerable evidence to support the changes. (AMSA has advocated for work-hour changes.)
For example, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, a December 2008 report from the IOM, called for changing residents' workloads and duty hours to protect patients against fatigue-related errors and to enhance the learning environment for doctors in training.
Moreover, even though 72 percent of the survey respondents said they were familiar with the proposed changes?and all received a short summary—Lazreg wonders how well they understand them. She's not surprised by the findings.
While she questions the survey's significance, she's most focused on education. And part of that requires healthcare leaders to make sure that residents and other staff members understand the changes—and the evidence behind them. It would, she says, be far more interesting to conduct the survey again once the residents understand both the changes and the evidence.