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Going the Distance: Should First-Year Residents Work Marathon Shifts?

When you think about your future as a doctor and the qualities you’ll need to be a successful one, stamina is undoubtedly on that list. Though the hours vary by specialty, medicine is not a path you choose for work-life balance. The long shifts required of first-year residents and their effects on patient safety as well as on opportunities for residents to learn are an ongoing controversy.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) imposed a 16-hour limit on shifts for first-year residents. A select group was allowed to work 30-hour shifts as part of a study funded in part by the National Institutes of Health that was designed to determine the effects of long shifts on patient outcomes and in-service learning.

Recently, the ACGME increased the limit to 24-hour shifts.

One school of thought, no pun intended, is that the extra-long shifts of yesteryear provided invaluable learning opportunities for residents. Those who fall in this camp argue that caring for the same individual patients, day and night, provides a continuity that allows them to do a more effective job. It allows first-year residents to be more fully-aware of all the variables that are relevant to a patient’s case and to take greater “ownership” of the patient. In addition, the night shift at a hospital tends to be a time when more specialists are on hand, providing more chances for residents to learn from their expertise.

Opponents of shifts that exceed 16-hours point to the dangers of sleep deprivation on patient care and doctor safety. Can a doctor running on caffeine who hasn’t slept in a day or more be expected to provide the highest quality of care to patients? As for learning opportunities, how well can they focus on adding to their knowledge base when their practically fading in and out?

These issues were known within the medical community prior to 1984 when an 18-year-old died during a visit to an emergency room where overworked residents with less than two years combined experience treated her. The case forced the debate into the spotlight and drove the push for hour-limitations in motion.

One solution that may satisfy those in favor of shorter hours would be to have patients alternate their evening shifts in a pattern that would allow them to spend adequate time with specialists but also follow patients through the complete cycle of treatment while maintaining a healthy energy level.

Some physicians actually believe shift limits have done more harm than good. While supporters of reduced working hours blame sleep deprivation for putting patients, doctors, and the public at risk, physicians who oppose shorter shifts argue that handoffs (changing doctors two to three times daily) are more responsible for mistakes. They also point out that by splitting the shift limits basically in half, doctors risk missing the first 24-hours of a patient’s admission, experience that is a crucial part of their training.