Teaching doctors: Fewer hours mean less learning

Among faculty surveyed, 87% said residents' care of patients has worsened because of a decline in continuity of care.

By Myrle Croasdale, AMNews staff. Sept. 10, 2007.

Internal medicine physicians who train residents say duty-hour limits have hurt future internists' patient care involvement, bedside learning and physician-patient relationships.

The national survey of 154 clinical faculty representing 39 programs also found that since the 80-hour work-week limit took effect in July 2003, it has improved residents' well-being but also increased faculty workloads and decreased their job satisfaction.

Steven Weinberger, MD, senior vice president of medical knowledge and publishing for the American College of Physicians, agreed with the findings published in the July 23 Archives of Internal Medicine. But he emphasized that implementing major changes can be a tumultuous process.

"The solution is not to bag the work hours, but what do we do to redesign training within the work hours," Dr. Weinberger said.

Study lead author Darcy Reed, MD, MPH, sees the findings as a tool to drive positive change, such as transitioning from the old model of one resident per patient to team-based care.

Among the findings, 87% of faculty surveyed said residents' continuity of care declined after duty-hour limits. Dr. Reed, an assistant professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn., suggested that faculty who trained under the traditional model would expect residents to be available to meet patients' needs as they arose, which implies working excessive hours. If faculty considered continuity in terms of a team, then high-quality care could still be provided without an individual resident's constant presence.