Following through on a proposal announced last November, the Accreditation Council for Graduate Medical Education (ACGME) said Friday that the with shifts not lasting more than 28 hours, beginning July 1.
The official maximum shift length will be 24 hours, but the new rule -- as in the earlier proposal -- allows for an additional 4 hours "to manage necessary care transitions."
Limits on duty hours will now be the same for first-year residents as well as for those further along in their training, including fellows. The policy also establishes that residents must have one work-free day each week, eliminates "moonlighting" for first-year residents, and counts work at home toward the 80-hour weekly maximum.
In 2011, the ACGME had reduced the maximum shift duration for first-year residents to 16 hours. However, the organization said, its task force on residency requirements "determined that the hypothesized benefits associated with the [2011 policy] have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole.
"It is important to note that 24 hours is a ceiling, not a floor," the ACGME continued in its announcement of the new standards. "Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive."
The consumer group Public Citizen and the American Medical Students Association, which have campaigned to keep the 2011 limits in place, quickly attacked the ACGME announcement.
"The ACGME's adoption of this dangerous proposal displays a reckless disregard for the lives and health of thousands of medical residents and their patients nationwide," said Public Citizen's Michael Carome, MD, in a press release.
And the same release quoted AMSA President Kelly Thibert, MD, who will begin her residency training this summer, as follows: "Extreme sleep deprivation and long hours are a holdover from the early 20th century when residents literally resided in the hospitals in which they trained. There is no reason to continue to subject medical trainees to mental and physical exhaustion for years on end, with the harm that ensues to them, their families, and their patients, simply to maintain an archaic tradition."
Claims of patient harm, however, were not backed up in a randomized trial of the longer shifts, at least for surgical residents. The so-called FIRST trial showed no significant differences in patient outcomes in centers with looser caps on duty hours, with some safety indicators favoring the longer shifts.
Another trial called iCOMPARE is still underway. Public Citizen and AMSA have criticized it as unethical