Improve GME

Duty-hours innovation needed: Report


While the medical profession needs continued investigation of resident duty-hours, it also needs to encourage new models for duty-hours requirements, physicians, residents and medical students agreed last month.

Based on a report from the AMA Council on Medical Education, physicians at the 2014 AMA Annual Meeting adopted new policy that supports duty-hours research to explore a variety of issues, including:

  • Patient safety
  • Trainees’ preparedness for practice
  • Workload and patient volume
  • Patient handoffs and continuity
  • Professionalism and personal responsibility

The new policy also encourages the study of innovative models of duty-hour requirements, including potentially creating specialty- or rotation-specific duty-hours requirements that would optimize competency-based learning opportunities.

The report highlights the AMA’s support for the Accreditation Council for Graduate Medical Education’s (ACGME) duty-hours standards, established in 2003, and encourages the ACGME to continue its duty-hours work. Specifically, the AMA will urge the ACGME to continue offering residency program incentives to ensure compliance with the standards, meeting with peer-selected or randomly selected residents during site visits, and collecting and sharing data on at-home call.

The AMA also will encourage the ACGME to:

  • Decrease barriers to reporting duty-hours violations and resident intimidation
  • Ensure that accessible, timely and accurate information about duty hours is not constrained by the cycle of ACGME site visits
  • Use recommendations from respective specialty societies and evidence-based approaches to any future revision of duty hours
  • Disseminate aggregate data from the annual ACGME survey on the educational environment of resident physicians

The ACGME in March announced it would waive certain duty-hour standards for two large national, multi-institutional resident trials. 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 for both trials. AMA policy supports these studies.

“Due to the wide range of issues that are related to duty hours and duty-hour limits, systemic change in residency education (and medical practice) may be needed to fully address this issue—beyond the simple metric of hours worked each week,” the report’s executive summary states. “This need is reflected in the work of the ACGME as it seeks to improve the quality and safety of residency training and move from a focus on process toward outcomes.”