Will reduced resident work hours improve the state of the art of healing?

At the outset, it might be best to say that the answer to the question of how reduced resident work hours will affect the art of healing is unsettled in the minds of most. The publication of the Institute of Medicine report, " To Err is Human: Building a Safer Health System, " in 2000 resulted in a national initiative to improve quality and safety in medicine [1]. More than a decade earlier, in 1988, New York state had restricted resident work hours to 80 hours a week and imposed rules for supervision. These restrictions came about as the result of an unfortunate hospital death and the assumption that a resident's fatigue was partly responsible for the death. Although numerous studies have failed to prove this assumption and the 80-hour limit was chosen arbitrarily, the Accreditation Council for Graduate Medical Education accepted and codified the New York legislation in 2003, mainly because it " made sense " that a better-rested resident would make fewer mistakes and that, therefore, patient outcomes would be better. So why are there still questions about this assumption? It should be understood that the 80-hour limit does not seriously impact residents in such specialties as radiology, pathology, dermatology, ophthalmology and others who never worked 80 hours a week on average to begin with. And the effect was minimal on pediatrics and internal medicine, where for years on-call coverage has averaged one night in four. The greatest impact has been on the surgical specialties where, because of patient volume and educational requirements, resident numbers have been limited, and night call has been every other or every third night. It should be noted that in 2004 the Blue Ribbon Committee of the American Surgical Association endorsed the 80-hour work week and proposed measures to implement safe, quality patient care while promoting an environment to reduce resident fatigue, improve family lifestyle and allow time for legitimate personal interests [2]. Literature is now accumulating about how work-hour limitations have affected different aspects of patient care and resident education and how new systems and approaches can accommodate the consequences of these changes. But have we achieved all that the work limitations were meant to achieve? It is useful to interpret this question with the understanding that the purpose of resident education is the production of a safe, knowledgeable, ethical physician who will place the interest of the patient before his or …