Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Dr. Kristen E. Fletcher
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
