News Release: School of Medicine

Dec. 2,  2008

Institute of Medicine Report Calls for Changes in Doctors Training

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The Institute of Medicine proposes in a report today revisions to medical residents' duty hours and workloads to decrease the chances of fatigue-related medical errors and to enhance the learning environment for these doctors-in-training.

"Fatigue, spotty supervision and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn," says committee chair Michael M.E. Johns, MD, chancellor of Emory University. 

The report does not recommend further reducing residents' work hours from the maximum average of 80 per week set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, but rather reduces the maximum number of hours that residents can work without time for sleep to 16, increases the number of days residents must have off and restricts moonlighting during residents' off-hours, among other changes.

"Health care facilities can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest," says Johns. 

"But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training," he says.

The committee, composed of medical and scientific experts from across the nation, also called for greater supervision of residents by experienced physicians, limits on patient caseloads based on residents' levels of experience and specialty, and overlap in schedules during shift changes to reduce the chances for error during the handover of patients from one doctor to another.

The report cites financial costs and an insufficient health care work force as the major barriers to further revising resident hours. It calls for additional funding for teaching hospitals, estimating that the additional costs associated with shifting some work from current residents to other health care personnel or additional residents could be in the ballpark of $1.7 billion per year.

Additional information on the report can be found at http://www.iom.edu/residenthours. Copies of the report are available from the National Academies Press; 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu

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