Revised hours and workloads for medical residents needed ...(ded periods of work without rest. But t...),Health

Studies showing the detrimental effects of fatigue on human performance underlie the committee's recommendations to reduce maximum shift lengths and to increase opportunities for residents to catch up on sleep. Because no single model of scheduling fits all training facilities or medical specialties, the committee offered two options for dealing with extended shifts. Residents either could work a maximum shift of 16 continuous hours or they could work a 30-hour shift provided that they get an uninterrupted five-hour break for sleep after working 16 hours. Sleep breaks during shifts should count toward the 80-hour limit. In addition, the committee recommended:

• There should be defined off-duty periods between shifts based on the timing and duration of shifts.
• The number of mandatory days off should increase.
• Medical moonlighting by residents during their off-hours should be restricted.

Violations of the current limits on duty hours occur frequently and are underreported, the committee found. ACGME's monitoring of training hospitals' compliance with the limits should be strengthened by having more frequent visits and making them unannounced.

Residency Review Committees need to establish standards of supervision for residents. The committee found that closer resident supervision leads to fewer errors, lower patient mortality, and improved quality of care. First-year residents, in particular, benefit from careful oversight and should not be on duty without immediate access to a supervisor on the premises, the report says.

Each medical specialty needs to set specific guidelines for the number of patients that residents in different years of post-gr
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