Capsule commentary on Garg et al., resident duty hours: a survey of internal medicine program directors.

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) implemented new Common Program Requirements in 2011 that regulate resident duty hours, updated from 2003. The new regulations aim to achieve greater safety and quality for patients under residents’ care and promote a learning environment in which physicians can engage in a healing relationship with their patients. Garg et al. explored perceptions of the duty hour requirements in a national sample of Internal Medicine Program Directors (IMPDs) 1 year after implementation.1 One of the most contentious pieces of the new regulations is the shift limit of 16 h. In this study, although a small majority of IMPDs reported overall approval of the duty hour regulations, only 17 % approved of the 16-h shift limit. This finding aligns with recent commentaries and studies that voice concern about a potential increase in a “shift mentality” and decline in professionalism in new physicians, as evidenced by residents not putting their patients’ needs above their own rest and recovery.2–4 This topic warrants further discourse among physicians and within the interdisciplinary healthcare team. Transitioning from a care model that is physician centric, where s/he perceives ownership of the patient, to one where the entire team of providers is responsible for the care of the patient is key to the achieve full compliance and uptake of the duty hour regulations. These findings and other work from this group5 could be complemented by a qualitative analysis that provides a more detailed understanding of the perceptions of the duty hour regulations and the nuances that arise across specialties. Finally, one finding that could have been contextualized further in the discussion by Garg et al. is that nearly three in four (72 %) IMPDs reported an increased workload as a result of the duty hour regulations. Increased workloads typically carry a negative connotation and may have biased the IMPDs responses on other items in the survey. Using objective measures to evaluate quality and safety related to duty hour regulations is also an area for future research.