Graduate Medical Education
Duty hours compliance remains elusive: Study
Since duty hour limits for resident/fellow physicians were instituted in 2003, data from the Accreditation Council for Graduate Medical Education (ACGME) have reflected a high rate of compliance among programs—as high as 95 percent.
This figure, however, has been contradicted by numerous published reports tracking resident work hours and anonymous resident surveys that identified frequent noncompliance and underreporting of duty hours. In fact, one study found that 83.6 percent of interns reported duty hour violations.
A new study, published in the Journal of Graduate Medical Education, raises similar concerns about compliance with the 2011 duty hour standards. Of the 6,202 residents surveyed, 52.9 percent reported some form of noncompliance, and almost as many admitted to falsifying duty hour reports. Residents earlier in their training reported higher rates of noncompliance, perhaps reflecting the difficulty of complying with the new 2011 requirement that caps intern shifts at 16 hours.
The authors believe their data reflects the conflict with which many residents are faced when required to choose between complying with the ACGME's standards and adhering to their ethical and professional standards of practicing medicine. Greater flexibility in duty hour standards is needed, they conclude, to allow for meeting the inevitable patient needs.
A related study, in Pediatrics, found that pediatric program directors reported negative effects from the duty hour standards on patient care as well as resident education and quality of life. As described in a Medscape article, nearly three of four respondents expressed disapproval of the 16-hour limit for interns. Further, fewer than half reported that their residents always complied with the 2011 regulations.
At the AMA Annual Meeting, delegates adopted policy recommending that the ACGME use evidence-based approaches to any future revision or introduction of resident duty hours rules. Learn more about the debate over resident duty hours on the AMA Resident and Fellow Section advocacy and policy Web page.
Research grants available for residents and fellows
The AMA Foundation is now accepting applications from medical students and resident/fellow physicians leading basic science, applied, or clinical research projects. The Seed Grant Research Program provides junior investigators with the opportunity to gain experience conducting research.
This year, grants of up to $2,500 will be awarded to support small research projects in the categories of cardiovascular/pulmonary diseases and pancreatic cancer.
Applications are due on Dec. 4.
Academic health centers and the cost/value equation
Although they represent the apex of American health care, academic health centers may face a challenging future as health care reform places increased focus on the cost/value equation, according to a recent viewpoint article in the Journal of the American Medical Association (JAMA).
Author Victor Fuchs, PhD, believes that the emphasis on eliminating "waste" disproportionately affects academic health centers, especially because they often are facilities equipped to provide optimum care with the latest technology. These considerations have a special impact on physicians in training. Teaching residents to weigh the cost of care against the absolute best course of treatment for the individual patient is controversial.
This topic was the centerpiece of an educational session at the Nov. 1 meeting of the AMA Section on Medical Schools. Participants considered how medical schools can ensure that physicians-in-training understand the need to consider cost of care in clinical decisions and to avoid overuse and misuse of resources.
Keynote speaker Steven E. Weinberger, MD, executive vice president and chief executive officer of the American College of Physicians, discussed the Choosing Wisely initiative and how to ensure medical students and resident/fellow physicians learn to practice the principles of high-value care.
In addition, co-keynote presenter Jacqueline A. Bello, MD, FACR, professor of clinical radiology and neurosurgery at Montefiore Medical Center and Albert Einstein College of Medicine, focused on the special challenges of teaching stewardship in procedural fields of medicine.
Learn more about the Section on Medical Schools and download the Nov. 1 meeting agenda book, which includes a number of insightful articles/studies on the topic of stewardship and the cost/value balance.
News and notes
- No effect of resident hour limits on neurosurgical outcomes (Medscape).
- Residents behaving badly? EBM (etiquette-based medicine) may be lacking (Journal of Hospital of Medicine).
AMA resources for residency programs and trainees
- Help your residents master the ACGME general competency requirements.
- Mentor students, residents and fellows via AMA program.
- Learn about the AMA Resident and Fellow Section.
- Learn about the AMA Council on Medical Education.
- Follow the AMA professional ethics Twitter page, and look for the #MedEdAMA hashtag for tweets on the AMA's Twitter page about medical education.