Beat the clock: The new challenges to residents

Residency programs now must adhere to an 80-hour workweek. How do residents do it and still learn all they need?

By Myrle Croasdale, AMNews staff. March 8, 2004.

It's dark outside and the lights are dimmed on the pediatric neurology ward at the University of Chicago's Bernard A. Mitchell Hospital. Christian Sikorski, MD, on morning rounds, checks on an infant with a shunt, a child with a severed spinal cord, another with electrodes protruding from his skull and one with a brain-damaging sinus infection.

Nurse practitioner Judy Holleman checks on other patients, then briefs Dr. Sikorski. Before July 1, 2003, Dr. Sikorski would have been rounding alone for the neurosurgery team.

Holleman's presence is one of several changes made in the neurology program at the University of Chicago to comply with new 80-hour workweek rules, which are reshaping medical training in the United States. For residency programs across the country, the challenge is to ensure that residents treat enough patients and perform enough procedures to become proficient and maintain patient safety during the increased number of patient handoffs that are the inevitable result of a shorter resident work day. Halfway through the first year of 80-hour weeks, it's still unclear whether the duty-hour limits have hurt residency training or whether patient safety has been affected. What is clear is that the programs that have made a successful transition have embraced a culture of change and have found ways to free residents from menial tasks.

Dr. Sikorski, a fourth-year resident, said nurse practitioners have cut hassles out of his day. A myriad of minor requests used to pile up while he was in surgery and his demand attention when he left the operating room.