By Cong Zhi Zhao, MD
Would it surprise you to know that the young doctor you are seeing has been up without sleep for up to 30 hours? If you received care at an academic facility with a neurology residency program this may not be an uncommon occurrence.
You may well be concerned about your doctor's performance, and you are not alone. The Accreditation Council for Graduate Medical Education (ACGME), the overseer of medical training issued work duty hour (WDH) recommendations in 2003 for residents. However even with limitation of work hours to less than 30 hours in a stretch there is still concern over the effects of sleep deprivation on medical care.
In 2008 the Institute of Medicine (IOM) made new recommendations that further limited work duty hours, mainly to limit shifts to 16 hours or 24 hours with 5 hour naps, with the goal of improving resident learning and patient safety. Some of these recommendations were to go into effect by July, 2011. While these recommendations are made with the best intentions and based on review of literature on sleep and medical education, there are few studies to look into how these recommendations would really impact the education of the resident and change patient care.
A study in the August 30 issue of Neurology® (read the abstract) looks at the impact of implementing these new recommendations at three large neurology residency programs.
This study had residents following the 2003 ACGME guidelines for one month and then switching to IOM recommendations for the second month. The residents were asked to answer surveys that evaluated resident sleepiness, burnout, fatigue impact and resident education satisfaction. The faculty was also surveyed regarding their satisfaction with the residents' work performance.
This study by Dr. Schuh and colleagues showed that while the IOM recommendations can be feasible in a large neurology program, the quality of life for residents did not improve as would be expected. The amount of sleep residents received and how sleepy the residents felt were no different during the IOM month. Burnout did not improve in the IOM month and the fatigue impact did not significantly favor the IOM month. The faculty at these residencies had a negative reaction to the IOM month and felt that resident knowledge about their patients suffered.
The study also suggests that some of the dissatisfaction on the residents' part was due to increased stress about the increased number of handovers (transfers of care due to changes in shift) and being less familiar with the patients. This study did not address direct patient outcomes.
While this study was relatively small and may be influenced by an existing prejudice against the new IOM recommendations, it suggests that the IOM recommendations may not have the intended effect, at least on resident quality of life. While we all realize that sleep deprivation is a factor in quality of your doctor's life and your safety as a patient, a one size fits all approach to doctor training hours may not be ideal.
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