I stumbled across this blog post today which examined the resident duty hour restrictions imposed by the Accreditation Council for Graduate Medical Education (ACGME) for physicians in training, specifically when applied to surgeons. The restrictions state that a trainee’s duty hours shall not exceed 80 hours per week. This has recently been amended, adding that no shift shall exceed 16 consecutive hours, as opposed to the 24-hour shifts we used to work when I was a resident. The whole goal is the idea that with residents more rested less medical errors will occur and preventable deaths will be avoided.
Interestingly enough, the article mentioned a few studies which showed that while trainee attitudes worsened with sleep deprivation, patient outcomes essentially do not change. The article makes some good points, however I’m not entirely convinced that it’s the duty hour restrictions that is directly limiting these new surgeons’ experience.
I was trained during the 80-hour work week era. I’ve spent entire 24-hour shifts of trauma call throwing up in between seeing patients as my fellow resident injected me with anti-nausea medication all night. Sleep deprivation comes with the territory. There’s no way not to be sleep deprived waking up at 4:30 a.m. every day for 5 years straight. I’m still sleep deprived. What I found though, is that no matter how sleep deprived I was when it came time to operate and take care of my patients I was always as wide awake and as alert as ever.
It doesn’t take an unlimited number of hours to make an experienced, committed and durable surgeon. But an excessively regulated, over-supervised system which encourages clock watching and stop everything when it’s time to go home doesn’t help either.
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