Excessive Work Hours of Physicians in Training in El Salvador: Putting Patients at Risk

Let us emancipate the student, and give him time and opportunity for the cultivation of his mind, so that in his pupilage he shall not be a puppet in the hands of others, but rather a self-relying and refl ective being. —Sir William Osler, Aphorisms from His Bedside Teachings and Writings R ecent studies involving physicians in training have shown that excessive work hours are associated with an increased rate of medical errors and adverse events. Studies of surgical residents found that they made up to twice the number of technical errors in the performance of simulated laparoscopic surgical skills after working overnight than after a night of sleep [1,2]. A landmark study of interns working in an intensive care unit found that they made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts [3]. A national prospective study of interns in the United States found that extended-duration work shifts (defi ned as at least 24 continuous hours at work) were associated with an increased risk of signifi cant medical errors, adverse events, and attentional failures [4]. According to the Institute of Medicine [5], preventable medical errors are responsible for the death of up to 98,000 people in the US every year, accounting for a higher mortality than car accidents, breast cancer, or AIDS. Although it is not known how many of these medical errors were due to fatigue, it is now acknowledged that fatigue associated with the excessive work hours of physicians in training is an important cause of medical errors. Hence, the issue of excessive work hours of physicians in training is becoming a public health priority in many countries worldwide. In the US and Europe, concerns about the effects of excessive work hours upon patient safety led to legislation on duty-hour restrictions [6–8], and more change seems to be on the way [9]. For example, the European Working Time Directive limits junior doctors' working hours to 56 hours per week (to be reduced to 48 hours by 2009) [8], but many countries, including El Salvador, have taken no steps at all to limit work hours of medical trainees. The current European maximum of 56 hours per week is less than half the time a physician in training works in El Salvador. Many other Latin American countries also force their junior doctors to work similarly excessive …