Revised Resident Duty Hour Standards Will Focus on Three Areas

Julie McCoy, April 8, 2010

The Accreditation Council for Graduate Medical Education (ACGME) Duty Hour Task Force cochairs Susan Day, MD, chair of the ACGME Board of Directors, and E. Stephen Amis Jr., MD, chair of the Council of Review Committees, provided the audience at the recent ACGME Annual Education Conference with a glimpse of what the committee is doing and what is left to do.

Day and Amis said the final chapters regarding duty hour reform have not been written.

In March, the committee heard from patient advocacy groups. Members of the task force will meet again for two days this month to finalize a draft of the new requirements. After completing the draft requirements, the task force will present the proposal to the Council of Review Committees for approval.

Next, the proposal will go to the ACGME board. The ACGME will then post the requirements on its Web site for public comment. The task force hopes to send a final draft to the ACGME board in September. Implementation of the new standards will likely occur in July 2011.

Day and Amis stressed the importance of adhering to this timeline. The Institute of Medicine's (IOM) 2008 report Resident Duty Hours: Enhancing Sleep, Supervision and Safety set a two-year deadline for the GME community to respond, and the ACGME believes it's important to meet that deadline.

Some members of the audience spoke about their concerns regarding the financial feasibility of implementing new requirements by July 2011. Many hospitals' 2011 budgets are due soon, and the new requirements may not be finalized until after the due dates have passed. Attendees who are responsible for developing budgets said they will have to guess the amount of additional funding needed to comply with new standards.

Day and Amis indicated that they are aware of the potential issues the timeline presents. The ACGME will commission an economic statement from the same group that worked with the IOM committee to determine the cost of the recommendations.

What the new standards will look like

Although there are not yet specifics of the new standards currently in development, Day and Amis did say the requirements will focus on the following three areas:

  • Duty hours. Day and Amis said the task force has heard loud and clear from the profession that a one-size-fits-all specialties policy will not work. They also acknowledged that there is no evidence to support a five-hour nap period for residents, as recommended in the IOM report. When asked about moonlighting and at-home call, Day and Amis did not give comment because the committee is still discussing these points.

  • Supervision. Day said the rules around supervision will be tightened. The new requirements will better define the components of supervision, and Residency Review Committees will develop specialty-specific standards in the future. It is likely that there will be different supervision standards regarding interactions with first-year residents and senior residents, Day said.

  • Professionalism. Day and Amis stressed that there are several aspects of professionalism that need to be addressed in the new requirements. The task force recognizes that professional responsibility must be developed in trainees. The task force has considered resident feedback stating that flexible duty hour limits are essential in allowing trainees to provide comprehensive patient care. Residents want to stay in the hospital if a patient develops complications, and the task force understands that continuity of care is essential to resident education.

Although it's difficult to determine how much work program directors, coordinators, and GME leaders will have to do to comply with new standards, the reality may be that the current system will need to change because of pressure from the government and public.

Julie McCoy is associate editor for HCPro's Residency Department. For more residency news, visit,

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