Resident Duty Hours: A Review

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Lindsay Melvin
Sophie Corriveau
Aiman Alak
Ameen Patel

patient safety, resident fatigue management


Residents are physicians undertaking further training to become independently licensed practitioners. Historically, resident duty hour periods were long and intense. The goal was to maximize learning through high patient volume and to teach doctors how to take responsibility. Recently, concerns over patient and resident safety have led to restricted trainee work hours. The putative justification is to improve resident education, resident well-being, and patient care. In light of this recent shift in the medical culture, resident duty hours have become a controversial topic. Restricted duty hours take many forms. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) mandated junior residents work no longer than 16 consecutive hours, while senior residents could work up to 26 hours.1 In Canada, no nationwide mandate exists and the issue falls within provincial jurisdiction. In Ontario, under the Professional Association of Residents of Ontario agreement, call-periods are no more than 26 consecutive hours in-house, no more than one in four nights in-house, or no more than one in three nights of home-call. After a 2011 Quebec court ruling, resident duty hours were restricted to 16 consecutive hours in that province. This resulted from the court concluding that traditional hours violate the Canadian Charter of Rights and Freedoms. Regardless, the Quebec ruling prompted other Canadian programs to further reduce resident duty hours and consecutive hours on-call. To better understand this complex issue, the following review discusses resident safety, resident performance, resident education, and patient safety. Our goal is to present a balanced, evidence-based discussion, addressing both patient safety and resident fatigue management.
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1. Nasca TJ, Day SH & Amis ES. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010;363(2): e3.

2. Barger LK et al. Extended work shifts and the risk of motor vehicle crashes among interns. NEJM 2005; 352: 125–134.

3. Marcus C & Loughlin G. Effect of sleep deprivation on driving safety in housestaff. Sleep 1996; 19: 763–766.

4. Arnedt JT et al. Neurobehavioural performance of residents after heavy night call vs after alcohol ingestion. JAMA 2005; 294: 1025–1033.

5. Lingenfelser TH et al. Young hospital doctors after night duty: their task-specific cognitive status and emotional condition. Med Educ. 1994; 28(6):566–572.

6. Fletcher KE et al. Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004; 141: 851–857.

7. Reed DA, Fletcher KE, Arora VM. Systematic review: association of shift length, protected sleep time, and night float with patient care, residents’ health, and education. Ann Intern Med. 2010; 153(12): 829–842.

8. Ahmed N et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014; 259(6): 1041–1053.

9. Goitein L et al. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med 2005; 165: 2601–2606.

10. Lefebvre DC. Resident physician wellness: a new hope. Acad Med 2012; 87: 598–602.

11. Auger KA et al. Better rested, but more stressed? Evidence of the effects of resident work hour restrictions. Acad Pediatr. 2012; 12(4): 335–343.

12. Sen S et al. Effects of the 2011 duty hour reforms on interns and their patients. JAMA Intern Med 2013; 173: 657–662.

13. Horwitz LI et al. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006; 166(11): 1173–1177.