Clinical question: What are the effects of the 2011 resident duty-hour requirements on first-year residents’ well-being and patient safety?
Background: In an effort to reduce adverse consequences associated with extended shift length and sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) released a new set of duty-hour requirements effective July 2011. To date, little is known about the effects of the 2011 reforms on resident and patient outcomes.
Study design: Prospective, longitudinal cohort with pre-post analysis.
Setting: Residency programs from university- and community-based medical centers.
Synopsis: Fifty-one residency programs from 10 university-based and four community-based GME institutions were included. Incoming interns during the 2009, 2010, and 2011 academic years were invited to participate, and 58% (n=2,323) agreed to take part. Participants completed online surveys two months before starting their first residency (intern) year and at three, six, nine, and 12 months of internship. Questions addressed work hours, sleep, medical errors, depressive symptoms, and subjective well-being.
No significant differences in baseline findings were found between the pre-implementation cohort (interns entering in 2009 and 2010) and the post-implementation cohort (interns starting in 2011, following the new duty-hour requirements). Interns in the post-implementation cohort worked fewer hours than those in the pre-implementation cohort (mean hours per week 64.3 vs. 67.0, P<0.001). There were no significant changes in reported hours of sleep, depressive symptom score, or well-being score between the pre- and post-implementation cohorts. The percentage of respondents who reported committing a serious medical error increased in the post-implementation group (23.3% vs. 19.9%, P=0.007).
Limitations include the self-reported nature of the responses and the modest participation rate. The authors concluded that although the 2011 reforms decreased the total number of hours worked, additional strategies could be needed to achieve the desired effects on intern well-being and patient safety.
Bottom line: Following implementation of the 2011 ACGME duty-hour reforms, interns from diverse specialties and institutions experienced reductions in self-reported work hours, without any associated improvements in sleep, depressive symptoms, or well-being and with an increase in reported medical errors.
Citation: Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657-662.