Two large national, multi-institutional resident trials could address key questions concerning the effects of duty-hour standards on patient care and safety and the professional training of physicians.
The Accreditation Council for Graduate Medical Education (ACGME) has agreed to waive certain duty-hour standards for the two trials, ACGME CEO Thomas J. Nasca, MD, said in a March 13 letter to the graduate medical education community. The core standards of 80-hour work weeks (averaged over four weeks), one day off for every seven worked (averaged over four weeks) and call no more frequently than every third night will remain in place during both trials. ACGME is providing seed money to both trials.
One trial, iCompare, will examine internal medicine residency programs, with a goal of conducting the first systematic, large-scale, multi-institutional randomized trial with a nationally representative group of academic and community hospitals.
The five-year trial will compare the current duty-hour standard that limits continuous duty to 16 hours with a new strategy, using a 28-hour maximum duty period with an embedded four-hour protected period for sleep. ACGME-accredited internal medicine residency programs are invited to apply for participation.
The other trial, involving general surgery residency programs over a two-year period, is called the FIRST Trial and will examine how increasing flexibility of surgical resident duty-hour requirements will affect patient care, surgical outcomes and resident perceptions.
Participating hospitals will be randomly selected for either an intervention group with flexibility of duty-hour restrictions or a control group adhering to current requirements. Hospitals that participate in the American College of Surgeons National Surgery Quality Improvement Program may enroll in the study.
“The question of duty-hour standards appropriately provokes great emotion in our community,” Dr. Nasca wrote. “While the vast majority of educators agree that some rational limits on resident duty hours are appropriate and salutary, we continue to have concerns that the specifics of our standards are not achieving the goals for which they were intended.”
A recent duty-hour study in the Journal of Hospital Medicine found that limits on the number of hours residents can work in a single shift have made no difference in patient safety. The ACGME first placed duty-hour restrictions on residents in 2003, intending to reduce medical errors, improve patient care and enhance resident quality of life.
